Provider Demographics
NPI:1396310629
Name:ALDA, SHELBY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:ALDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:EAST TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730-9785
Mailing Address - Country:US
Mailing Address - Phone:989-329-0221
Mailing Address - Fax:
Practice Address - Street 1:2865 S LINCOLN RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-9085
Practice Address - Country:US
Practice Address - Phone:989-773-7747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist