# LEE SHETTLE DO PA

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

## Provider details

- **NPI number:** 1780981779
- **Authorized official:** DR. PHILIP LEE SHETTLE DO (OWNER)
- **Authorized official phone:** (727) 674-2500

## Contact information

- **Practice address:** 13113 66TH ST N, LARGO, FL 33773-1812
- **Practice address phone:** (727) 674-2500
- **Practice address fax:** (727) 674-2550
- **Mailing address:** 13113 66TH ST N, LARGO, FL 33773-1812
- **Mailing address phone:** (727) 674-2500
- **Mailing address fax:** (727) 674-2550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | OS6621 | FL | Yes |

## Other

- **Enumeration date:** 02/28/2011
- **Last updated:** 12/16/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 180045006 | RAILROAD MEDICARE | FL |
| 05 | — | 378381200 | — | FL |
| 01 | — | 80884 | BCBS OF FLORIDA | FL |