Provider Demographics
NPI:1306940796
Name:SHELTON, STEVE MICHAEL (OD)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:MICHAEL
Last Name:SHELTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 BEECH TREE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6001
Mailing Address - Country:US
Mailing Address - Phone:910-451-5249
Mailing Address - Fax:910-451-5381
Practice Address - Street 1:1401 WEST RD.
Practice Address - Street 2:MCCS COMPLEX BLDG. 1231
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:910-451-5249
Practice Address - Fax:910-451-5381
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0999152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093KJOtherBCBS STATE/FED. PROVIDER
NC7453310OtherAETNA PROVIDER NUMBER
NC7453310OtherAETNA PROVIDER NUMBER
NC246306DMedicare ID - Type UnspecifiedPROVIDER NUMBER