Timothy Dane Shelley, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046006644 Issued in IL

Practice address

3287 Court St
Pekin, IL 61554-6208

Phone

(309) 353-9313

Fax

(309) 353-4962

NPI assigned

Sep 30, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389312000000",
    "number": "1699762047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8309 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616152170",
            "telephone_number": "309-693-9540",
            "fax_number": "309-693-9542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3287 COURT ST",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546208",
            "telephone_number": "309-353-9313",
            "fax_number": "309-353-4962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELLEY",
        "first_name": "TIMOTHY",
        "middle_name": "DANE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2014-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046006644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "410033413",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046006644",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "7215175",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Huma Shamim, MD
• Melissa Shane
• Jessie Shanks, LMHC, LCPC
• Amanda Sharp-Potter
• Cory M Sharp, PA-C
• Alison Sherren, AU.D., CCC-A
• Cindy Ann Sidell, DSP RSA CNA
• Janice C Sigulas, P. T.
• Dawn Sikorski, LOTR,CHT
• Barbara Sue Simpson

• Optometrist in Pekin, IL
• Providers in Pekin, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.