Provider Demographics
NPI:1962022137
Name:CHELSEY SHEPOS, LLC
Entity Type:Organization
Organization Name:CHELSEY SHEPOS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELSEY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:SHEPOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:412-527-9466
Mailing Address - Street 1:4962 BALLANTRAE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-3061
Mailing Address - Country:US
Mailing Address - Phone:412-527-9466
Mailing Address - Fax:
Practice Address - Street 1:1030 WEST BAY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770
Practice Address - Country:US
Practice Address - Phone:727-585-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty