Provider Demographics
NPI:1164004065
Name:SHALIMAR EYE CARE, PA
Entity Type:Organization
Organization Name:SHALIMAR EYE CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:COOK
Authorized Official - Last Name:BATSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-613-6588
Mailing Address - Street 1:10 OLD FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-4201
Mailing Address - Country:US
Mailing Address - Phone:850-613-6588
Mailing Address - Fax:850-613-6574
Practice Address - Street 1:10 OLD FERRY RD
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-4201
Practice Address - Country:US
Practice Address - Phone:850-613-6588
Practice Address - Fax:850-613-6574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty