Provider Demographics
NPI:1952450256
Name:SPURGESS, SHELLY CHUMBLER (OD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:CHUMBLER
Last Name:SPURGESS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:BRIEN
Other - Last Name:CHUMBLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:9412 VILLAGE PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2084
Mailing Address - Country:US
Mailing Address - Phone:810-852-4174
Mailing Address - Fax:810-852-4179
Practice Address - Street 1:9412 VILLAGE PLACE BLVD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2084
Practice Address - Country:US
Practice Address - Phone:810-852-4174
Practice Address - Fax:810-852-4179
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-B32-TA-732152W00000X
MI4901004626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist