| Organization Name: | WILLIAM R. SHOCKLEY, OD |
| NPI Number: | 1669644522 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM SHOCKLEY (OWNER/OPTOMETRIST) |
| Mailing Address: | 47 Jefferson St Newnan |
| State: | GA US |
| Postal Code: | 302631948 |
| Phone Number: | 7702540200 |
| Fax Number: | 7702541281 |
| NPI Enumeration Date: | 03/31/2008 |
| NPI Last Update Date: | 07/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 0786430001 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |