Type 1 · Individual ✓ Active NPI ✓ Valid NPI checksum
Kenneth Trevor Shealy, O.D.
Optometrist in Tifton, GA · enumerated 2020.
Data current as of Jul 13, 2026 · sourced from CMS NPPES
National Provider Identifier
1104436922
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Registry record
Entity type Individual (Type 1)
Name Kenneth Trevor Shealy
Credential O.D.
Sex Male
Practice address 1803 Old Ocilla Rd, Tifton, GA, 31794
Phone (229) 386-2181
Fax (229) 386-2193
Enumeration date Aug 6, 2020
Last updated in NPPES Aug 23, 2024
Taxonomy & licenses
OD · Doctor of Optometry: A licensed optometrist providing primary vision care, eye exams, and corrective lenses.
About the OD credential
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OPT003252 | Other | GA | OPTOMETRY LICENSE |
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.
Frequently asked questions
How do I verify Kenneth Shealy's NPI record?
Cross-check NPI 1104436922 against the official CMS registry at npiregistry.cms.hhs.gov. This page mirrors the same public NPPES data with a monthly snapshot.
Is NPI 1104436922 active?
Yes, as of the latest NPPES snapshot, NPI 1104436922 is active (record last updated 2024-08-23).
Other providers at this practice address
Browse all → Robert Holme Ophthalmology Physician · Tifton, GA NPI 1336150648 Bret Wagenhorst Ophthalmology Physician · Tifton, GA NPI 1841201134 Larry R Moorman M D, PC Ophthalmology Physician · Tifton, GA NPI 1225193329 Amedco Georgia LLC Ophthalmology Physician · Tifton, GA NPI 1962846352 Tifton Ophthalmology Associates. PC Ophthalmology Physician · Tifton, GA NPI 1316343452 Tift Regional Health System Inc. Eyewear Supplier · Tifton, GA NPI 1639814296
Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2024-08-23.