Provider Demographics
NPI:1215964770
Name:SHELOR, THOMAS R (OD PA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:SHELOR
Suffix:
Gender:M
Credentials:OD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:401 S CLAIRBORNE RD
Mailing Address - Street 2:STE B
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1735
Mailing Address - Country:US
Mailing Address - Phone:913-782-1213
Mailing Address - Fax:913-782-4801
Practice Address - Street 1:401 S CLAIRBORNE RD
Practice Address - Street 2:STE B
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1735
Practice Address - Country:US
Practice Address - Phone:913-782-1213
Practice Address - Fax:913-782-4801
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1075-2152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4526530001OtherCIGNA MEDICARE DMERC
KS04524021OtherBC BS OF KC
KS4526530001OtherCIGNA MEDICARE DMERC
KS04524021OtherBC BS OF KC
KSM661931Medicare ID - Type Unspecified