Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kenneth Trevor Shealy, OD

Individual provider Optometrist · NPI 1104436922

Kenneth Trevor Shealy, OD is an Optometry in Tifton, Georgia. Graduated from Southern College of Optometry in 2020, 6 years ago. Practices with Tift Regional Health System Inc, a 292-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
6
Trained at
Southern College of Optometry
Licensed in
GA
In the registry since
2020
What do these letters mean?
OD — Doctor of Optometry
An optometrist: examines eyes, prescribes glasses and contacts, and treats many eye conditions.

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Practice location Address checks out

1803 Old Ocilla Rd
Tifton, GA 31794-1617
Phone: (229) 386-2181
Fax: (229) 386-2193
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Optometrist (primary) Taxonomy 152W00000X · Licence OPT003252 (GA)

Record details

NPI number1104436922
Entity typeIndividual (Type 1)
GenderMale
Credentials OD
Sole proprietorNo
NPI enumeratedAugust 6, 2020
Last updated in NPPESAugust 23, 2024
Certification dateAugust 23, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOPTOMETRY
Medical schoolSOUTHERN COLLEGE OF OPTOMETRY
Graduated 2020 (6 years in practice)
Group practice Tift Regional Health System Inc — 292 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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