Organization
JERVEY EYE GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN WELLS SHELLEY MD (AUTHORIZED OFFICIAL)
(864) 250-6487
Entity
Organization
Contact information
Practice address
5 STEVENS ST STE 100, GREENVILLE, SC 29605-4528
(864) 250-6487
(864) 250-6475
Mailing address
601 HALTON RD, GREENVILLE, SC 29607-3403
(864) 250-6487
(864) 250-6475
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
—
DA9938
MEDICAID DMERC
SC
01
—
DM0382
MEDICAID DMERC NUMBER
SC
05
—
GP0900
—
SC
Enumeration date
01/26/2006
Last updated
09/14/2023
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