Philip Lee Shettle, D.O.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

OS 6621 Issued in FL

Practice address

13113 66TH St
Largo, FL 33773-1812

Phone

(727) 674-2500

Fax

(727) 674-2550

NPI assigned

Jul 12, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Philip Lee Shettle Professional name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lee Shettle DO PA

  • Ophthalmology Physician
  • Largo, FL
  • NPI 1780981779
  Medicare reassignment NPD Authorized official
• Optometric Associates of Florida, P.a.

  • Optometrist
  • Largo, FL
  • NPI 1346316676
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608076800000",
    "number": "1023016243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13113 66TH ST",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337731812",
            "telephone_number": "727-674-2500",
            "fax_number": "727-674-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13113 66TH ST",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337731812",
            "telephone_number": "727-674-2500",
            "fax_number": "727-674-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHETTLE",
        "first_name": "PHILIP",
        "middle_name": "LEE",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CO",
            "license": "32591",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "5101010879",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "OS 6621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "378381200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180045006",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "80884",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHILIP",
            "last_name": "SHETTLE",
            "middle_name": "LEE",
            "credential": "D.O.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Sheridan Radiology Services of Kentucky, Inc
• Sheridan Radiology Services of Pinellas, Inc.
• Christopher Michael Sherman, M.D.
• Robert James Shermeta, DPM
• Shettle Optical Solutions,Inc.
• Philip Leroy Shettle, D.O.
• Todd Alan Shettle, O.D.
• Kedar R. Shetye, M.D.
• Paul Daniel Shimkonis, PTA
• Kathleen Demolli Shirley, PT,OCS,GCS

• Ophthalmology Physician in Largo, FL
• Providers in Largo, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.