Individual provider Active NPI

Logan Scott Shettle, O.D.

  • Optometrist
  • St Petersburg, FL
National Provider Identifier
1417847880
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
6747 Issued in FL
Practice address
8501 4TH St N
St Petersburg, FL 33702-3110
Phone
(727) 528-2015
Fax
(727) 528-2015
NPI assigned
Jul 8, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 6747 FL Primary

Addresses

Primary practice location

8501 4TH St N
St Petersburg, FL 33702-3110

Mailing address

8501 4TH St N
St Petersburg, FL 33702-3110
Phone (727) 528-2015

Medicare participation

Medicare enrollment files
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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250902001441 FL Practitioner - Optometry 2567963465 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
D Scott Shettle OD PAGroup PAC ID 8123178175, 2 clinicians

Practice addresses (Care Compare)

8501 4TH St N
Saint Petersburg, FL 33702-3110
Phone (727) 528-2015

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6747FLMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
D Scott Shettle OD PA CurrentSince Jun 26, 2025 Accepting new patients

Locations

8501 4th St N
St Petersburg, FL 33702
Phone (727) 528-2015

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1751932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1417847880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8501 4TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337023110",
            "telephone_number": "727-528-2015",
            "fax_number": "727-528-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8501 4TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337023110",
            "telephone_number": "727-528-2015",
            "fax_number": "727-528-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHETTLE",
        "first_name": "LOGAN",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-07-08",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "6747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.