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Organization
JERVEY EYE GROUP, PA
Active
Organization
JERVEY EYE GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN W SHELLEY MD (AUTHORIZED OFFICIAL)
(864) 458-7956
Entity
Organization
Contact information
Practice address
220 S PENDLETON ST, EASLEY, SC 29640-3048
(864) 859-3233
(864) 850-4001
Mailing address
601 HALTON RD, GREENVILLE, SC 29607-3403
(864) 458-7956
(864) 458-8390
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1362
SC
152W00000X
Optometrist
910
SC
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN1549
MEDICARE RAILROAD
SC
05
—
DA9934
—
SC
01
—
DM0384
MEDICAID DMERC
SC
05
—
GP0898
—
SC
Enumeration date
01/26/2006
Last updated
09/14/2023
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