Rachel Shackelford, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG004030 Issued in PA

Practice address

1200 W Godfrey Ave
Philadelphia, PA 19141-3323

Phone

(215) 276-6000

Fax

(215) 276-6096

NPI assigned

Jul 5, 2023

Last updated

Jul 5, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

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

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

International Eyecare Center LLCGroup PAC ID 0244125235, 20 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rachel.shackelford.p1@direct.salusuhealth.nextgenshare.com

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

• International Eyecare Center LLC

  • Optometrist
  • Quincy, IL
  • NPI 1760405047

  NE

  Medicare reassignment Care Compare group NPD
• Pennsylvania College of Optometry

  dba The Eye Institute

  • Optometrist
  • Philadelphia, PA
  • NPI 1134166572
  NPD
• International Eyecare Center Inc

  dba Malbar Vision

  • Optometrist
  • Omaha, NE
  • NPI 1386825610
  NPD
• International Eyecare Center, Inc.

  dba Malbar Vision

  • Optometrist
  • La Vista, NE
  • NPI 1740461979
  NPD (past)

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

{
    "created_epoch": "1688515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1841978418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W GODFREY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413323",
            "telephone_number": "215-276-6000",
            "fax_number": "215-276-6096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W GODFREY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413323",
            "telephone_number": "215-276-6000",
            "fax_number": "215-276-6096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "RACHEL",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-05",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG004030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danya Leigh Shabi, DMD
• Leah Shabo, MD
• Nogah Shabshin, MD
• Jonathan Shack, MD
• Ashley L Shackelford
• Christopher Shackleford, DO
• Shadana Davis, PSYD PLLC
• Robert E Shaddy, MD
• Ronnie Shade Jr., DO
• Noel L Shadowen, PHD

• Optometrist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; 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.