Provider Demographics
NPI:1437791076
Name:SHIPLEY & WAYLAND EYECARE LLC
Entity Type:Organization
Organization Name:SHIPLEY & WAYLAND EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CONSULTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-578-4550
Mailing Address - Street 1:192 GRANDMAR CHASE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-6409
Mailing Address - Country:US
Mailing Address - Phone:404-784-4758
Mailing Address - Fax:
Practice Address - Street 1:7768 CUMMING HWY STE 500
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-2984
Practice Address - Country:US
Practice Address - Phone:470-863-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000919322AMedicaid