Provider Demographics
NPI:1922351337
Name:SHELTON O.D. PC
Entity Type:Organization
Organization Name:SHELTON O.D. PC
Other - Org Name:SHELTON EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-818-1827
Mailing Address - Street 1:501 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-4662
Mailing Address - Country:US
Mailing Address - Phone:540-818-1827
Mailing Address - Fax:
Practice Address - Street 1:4812 VALLEY VIEW BLVD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2018
Practice Address - Country:US
Practice Address - Phone:540-362-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0618000777OtherSTATE OPTOMETRY TPA LICENSE JEFFREY SHELTON O.D.
VA0618000777OtherSTATE OPTOMETRY TPA LICENSE JEFFREY SHELTON O.D.
MS1597131OtherFEDERAL DEA NUMBER JEFFREY SHELTON O.D.