Provider Demographics
NPI:1487706206
Name:POIRRIER, SHELLEY (OD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:POIRRIER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 BEE CAVE RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5676
Mailing Address - Country:US
Mailing Address - Phone:512-327-3605
Mailing Address - Fax:512-327-3605
Practice Address - Street 1:2712 BEE CAVE RD
Practice Address - Street 2:SUITE 118
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5676
Practice Address - Country:US
Practice Address - Phone:512-327-3605
Practice Address - Fax:512-327-3605
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5923T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU85274Medicare UPIN
TX83555EMedicare ID - Type Unspecified