Provider Demographics
NPI:1548746720
Name:ROCKWELL, SHELBY (OD)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:ROCKWELL
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 1:6500 PORTER RD STE 2020
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1529
Mailing Address - Country:US
Mailing Address - Phone:716-282-1114
Mailing Address - Fax:716-282-0523
Practice Address - Street 1:6500 PORTER RD STE 2020
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1529
Practice Address - Country:US
Practice Address - Phone:716-282-1114
Practice Address - Fax:716-282-0523
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008833-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGOtherMEDICARE