Organization
JERVEY EYE GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN WELLS SHELLEY MD (AUTHORIZED OFFICIAL)
(864) 458-3900
Entity
Organization
Contact information
Practice address
1 COLONY CENTRE WAY, SIMPSONVILLE, SC 29681-3286
(864) 458-3900
(864) 967-9118
Mailing address
601 HALTON RD, GREENVILLE, SC 29607-3403
(864) 458-7956
(864) 458-8390
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN1548
MEDICARE RAILROAD
SC
01
—
DE1061
MEDICAID DMERC NUMBER
SC
05
—
GP1669
—
SC
Enumeration date
01/26/2006
Last updated
09/14/2023
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