Organization
JERVEY EYE GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN W SHELLEY MD (PRESIDENT)
(864) 458-7956
Entity
Organization
Contact information
Practice address
601 HALTON RD, GREENVILLE, SC 29607-3403
(864) 458-7956
(864) 458-8390
Mailing address
601 HALTON RD, GREENVILLE, SC 29607-3403
(864) 458-7956
(864) 458-8390
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
646
SC
207W00000X
Ophthalmology Physician
11002
SC
207W00000X
Ophthalmology Physician
14023
SC
207W00000X
Ophthalmology Physician
17064
SC
207W00000X
Ophthalmology Physician
24224
SC
207W00000X
Ophthalmology Physician
Primary
28578
SC
207W00000X
Ophthalmology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN1548
MEDICARE RAILROAD
SC
05
—
DA9934
—
SC
01
—
DM0381
MEDICAID DMERC NUMBER
SC
05
—
GP0901
—
SC
Enumeration date
01/25/2006
Last updated
09/23/2025
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