Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | VA |
NPI | 1194211482 |
---|---|
Provider Name | Chelsea Shelton |
First Address | Portsmouth, VA 23703-3200 |
Second Address | Portsmouth, VA 23703-3200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 10/07/2018 |