Lee Shettle DO PA

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

OS6621 Issued in FL

Legal business name

LEE SHETTLE DO PA

Practice address

13113 66TH St N
Largo, FL 33773-1812

Phone

(727) 674-2500

Fax

(727) 674-2550

NPI assigned

Feb 28, 2011

Last updated

Dec 16, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Philip Lee Shettle, DONPI 1023016243

Title

Owner

Phone

(727) 674-2500

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Philip Lee Shettle, D.O.

  • Ophthalmology Physician
  • Largo, FL
  • NPI 1023016243
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1298851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608076800000",
    "number": "1780981779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13113 66TH ST N",
            "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 N",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337731812",
            "telephone_number": "727-674-2500",
            "fax_number": "727-674-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEE SHETTLE DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-28",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A",
        "authorized_official_last_name": "SHETTLE",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-674-2500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "OS6621",
            "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": []
}

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• Patrice Danielle Lee-Seyon, D.C.
• Christopher T Lee, M.D.
• Lauren Lee, OD
• Legacy Health Medical Group, LLC
• Christopher Leibold

• 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.
• 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.