Provider Demographics
NPI:1992923171
Name:SHAPPLEY EYE CLINIC PLLC
Entity type:Organization
Organization Name:SHAPPLEY EYE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHAPPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-286-6171
Mailing Address - Street 1:804 CHILDS ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-4933
Mailing Address - Country:US
Mailing Address - Phone:662-286-6171
Mailing Address - Fax:662-287-3937
Practice Address - Street 1:804 CHILDS ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-4933
Practice Address - Country:US
Practice Address - Phone:662-286-6171
Practice Address - Fax:662-287-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS542152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS425233202AOtherBLUE CROSS BLUE SHIELD
MS09015503Medicaid
MS410044588OtherRAILROAD MEDICARE
MS168727OtherEYEMED
MS57711OtherDAVIS VISION
MS18147OtherSPECTERA
MS57711OtherDAVIS VISION
MS09015503Medicaid