Provider Demographics
NPI:1437257946
Name:ROTEN, SHELLEY DEE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:DEE ANN
Last Name:ROTEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 110TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-7326
Mailing Address - Country:US
Mailing Address - Phone:806-543-4566
Mailing Address - Fax:
Practice Address - Street 1:4004 82ND ST STE 200
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2064
Practice Address - Country:US
Practice Address - Phone:806-743-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4700TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist