Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 542 | MS |
NPI | 1003034380 |
---|---|
Provider Name | Dr. Robert W Shappley |
First Address | Corinth, MS 38834-4933 |
Second Address | Corinth, MS 38834-4933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0880143 | (05) | MS |