Provider Demographics
NPI:1174940142
Name:SHELL POINT FAMILY EYECARE & OPTICAL LLC
Entity type:Organization
Organization Name:SHELL POINT FAMILY EYECARE & OPTICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-915-3422
Mailing Address - Street 1:204 MIDTOWN DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-5203
Mailing Address - Country:US
Mailing Address - Phone:843-521-4037
Mailing Address - Fax:843-521-0138
Practice Address - Street 1:204 MIDTOWN DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-5203
Practice Address - Country:US
Practice Address - Phone:843-521-4037
Practice Address - Fax:843-521-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1568152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPTAN: 7121350001OtherNATIONAL SUPPLIER CLEARINGHOUSE SUPPLIER OF DURABLE MEDICAL EQUIPMENT
SCPTAN: 7121350001OtherNATIONAL SUPPLIER CLEARINGHOUSE SUPPLIER OF DURABLE MEDICAL EQUIPMENT