Provider Demographics
NPI:1528410461
Name:LOMAX, SHELLY ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:ELIZABETH
Last Name:LOMAX
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 1:1655 E GREENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2062
Mailing Address - Country:US
Mailing Address - Phone:864-224-6375
Mailing Address - Fax:
Practice Address - Street 1:1655 E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2062
Practice Address - Country:US
Practice Address - Phone:864-224-6375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-04
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN3330152W00000X
SCSC1945152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist