Provider Demographics
NPI:1912937855
Name:SHELTON, JEFFREY CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:SHELTON
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BLUE RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-2442
Mailing Address - Country:US
Mailing Address - Phone:540-587-4000
Mailing Address - Fax:888-321-8434
Practice Address - Street 1:801 BLUE RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2442
Practice Address - Country:US
Practice Address - Phone:540-587-4000
Practice Address - Fax:888-321-8434
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000777152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA159000OtherANTHEM
VA11527372OtherCAQH PROVIDER ID
VA152W00000XOtherNPI
VA0618000777OtherVIRGINIA OD LICENSE
VA11527372OtherCAQH PROVIDER ID