Provider Demographics
NPI:1336296219
Name:STEVE M. SHELTON O.D.
Entity Type:Organization
Organization Name:STEVE M. SHELTON O.D.
Other - Org Name:BASE VISION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-451-5249
Mailing Address - Street 1:1021 BEECH TREE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6001
Mailing Address - Country:US
Mailing Address - Phone:910-451-5249
Mailing Address - Fax:910-451-5381
Practice Address - Street 1:1401 WEST RD.
Practice Address - Street 2:MCCS COMPLEX BLDG.1231
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28452
Practice Address - Country:US
Practice Address - Phone:910-451-5249
Practice Address - Fax:910-451-5381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0999152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7453310OtherAETNA PROVIDER NUMBER
NC093KJOtherBCBS STATE&FED. PROVIDER
NC7453310OtherAETNA PROVIDER NUMBER
NCT64851Medicare UPIN