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Individual

BRENT EDWARD SHELLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
1400 COMMON DR, EL PASO, TX 79936-5922
(915) 595-4375
(915) 595-4460
Mailing address
1400 COMMON DR, EL PASO, TX 79936-5922
(915) 595-4375
(915) 595-4460

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9924
TX
152W00000X
Optometrist
OP2549
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
200151153
UNITED HEALTH CARE
NM
01
91360
PRESBYTERIAN HEALTH INS
NM
01
NM00PB21
BCBS OF NM
NM
Enumeration date
08/02/2006
Last updated
02/11/2020
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