Provider Demographics
NPI:1285369884
Name:POPE, SHIRAH RENEE (LDO)
Entity type:Individual
Prefix:
First Name:SHIRAH
Middle Name:RENEE
Last Name:POPE
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WALMART VISION CENTER
Mailing Address - Street 2:6134 WHITE HORSE ROAD
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611
Mailing Address - Country:US
Mailing Address - Phone:864-295-0412
Mailing Address - Fax:864-295-0419
Practice Address - Street 1:WALMART VISION CENTER
Practice Address - Street 2:6134 WHITE HORSE ROAD
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611
Practice Address - Country:US
Practice Address - Phone:864-295-0412
Practice Address - Fax:864-295-0419
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101002887333600000X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No333600000XSuppliersPharmacy