Provider Demographics
NPI:1265209282
Name:SHATLEH OPTOMETRY, PLLC
Entity type:Organization
Organization Name:SHATLEH OPTOMETRY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHATLEH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:346-338-4581
Mailing Address - Street 1:3615 TUMBLING FALLS DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4895
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19804 MORRIS AVENUE
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3708
Practice Address - Country:US
Practice Address - Phone:832-661-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty