Provider Demographics
NPI:1588308902
Name:SHEALY, ERIN MOZINGO (OD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MOZINGO
Last Name:SHEALY
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 1:416 TIFT AVE N
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4466
Mailing Address - Country:US
Mailing Address - Phone:229-244-2068
Mailing Address - Fax:
Practice Address - Street 1:416 TIFT AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4466
Practice Address - Country:US
Practice Address - Phone:229-244-2068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003415152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist