# JERVEY EYE GROUP, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538139803
- **Authorized official:** BRIAN WELLS SHELLEY MD (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (864) 250-6487

## Contact information

- **Practice address:** 5 STEVENS ST STE 100, GREENVILLE, SC 29605-4528
- **Practice address phone:** (864) 250-6487
- **Practice address fax:** (864) 250-6475
- **Mailing address:** 601 HALTON RD, GREENVILLE, SC 29607-3403
- **Mailing address phone:** (864) 250-6487
- **Mailing address fax:** (864) 250-6475

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/26/2006
- **Last updated:** 09/14/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CN1548 | MEDICARE RAILROAD | SC |
| 01 | — | DA9938 | MEDICAID DMERC | SC |
| 01 | — | DM0382 | MEDICAID DMERC NUMBER | SC |
| 05 | — | GP0900 | — | SC |