Provider Demographics
NPI:1427183540
Name:SHETLER, PHILIP JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JAMES
Last Name:SHETLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SCEVA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43044
Mailing Address - Country:US
Mailing Address - Phone:937-834-3333
Mailing Address - Fax:
Practice Address - Street 1:2270 ELIDA ROAD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805
Practice Address - Country:US
Practice Address - Phone:419-331-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist