Active NPI
Jessica Shockley, C.O.A
- Ophthalmic Assistant
- Dayton, OH
National Provider Identifier
1215299375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmic Assistant
- License
- 180446
- Practice address
- 105 Sugar Camp Cir
Suite 200
Dayton, OH 45409-1962 - Phone
- (937) 222-3937
- Fax
- (937) 223-5254
- NPI assigned
- Jun 13, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmic Assistant | 156FX1101X | 180446 | OH | Primary |
Addresses
Primary practice location
105 Sugar Camp Cir
Suite 200
Dayton, OH 45409-1962
Mailing address
105 Sugar Camp Cir
Suite 200
Dayton, OH 45409-1962
Phone (937) 222-3937
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180446 | OH | MD | Ophthalmic Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339545600000",
"number": "1215299375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 SUGAR CAMP CIR",
"address_2": "SUITE 200",
"city": "DAYTON",
"state": "OH",
"postal_code": "454091962",
"telephone_number": "937-222-3937",
"fax_number": "937-223-5254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 SUGAR CAMP CIR",
"address_2": "SUITE 200",
"city": "DAYTON",
"state": "OH",
"postal_code": "454091962",
"telephone_number": "937-222-3937",
"fax_number": "937-223-5254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOCKLEY",
"first_name": "JESSICA",
"credential": "C.O.A",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-13",
"last_updated": "2012-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1101X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Ophthalmic Assistant",
"state": "OH",
"license": "180446",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.