Provider Demographics
NPI:1912937855
Name:SHELTON, JEFFREY CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:SHELTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:3051 VALLEY AVE STE 102
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2658
Practice Address - Country:US
Practice Address - Phone:540-450-8504
Practice Address - Fax:540-450-8507
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000777152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11527372OtherCAQH PROVIDER ID
VA0618000777OtherVIRGINIA OD LICENSE
VA152W00000XOtherNPI
VA159000OtherANTHEM
VA11527372OtherCAQH PROVIDER ID