DR. LOGAN SCOTT SHETTLE (O.D.) – Optometrist, NPI 1417847880

DR. LOGAN SCOTT SHETTLE (O.D.) is a healthcare provider. based in St petersburg, Florida. specializing in OPTOMETRY. They hold the professional credentials O.D.. They hold a License No. 6747 (FL). The NPI Number for DR. LOGAN SCOTT SHETTLE (O.D.) is 1417847880

Main info

Male
Sole Proprietor
1 Year Of Experience
Accepts Medicare Assignment
Name
DR. LOGAN SCOTT SHETTLE (O.D.)
NPI
1417847880
Phone
(727) 528-2015
Address
8501 4TH ST N
Enumeration Date
8 July 2025
Last Update Date
15 July 2025

Doctor Profile

Medical School Name
SOUTHERN COLLEGE OF OPTOMETRY
Secondary Phone
7275282015
Graduation Year
2025 (1 year ago)
PAC ID
2567963465
Group Practice PAC ID
8123178175
Professional Enrollment ID
I20250902001441
Address ID
FL337023110SA8501XNXXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness85
Years active:0State licenses:1Digital endpointsOther names

2,055 OPTOMETRY in FL

Provider Addresses for DR. LOGAN SCOTT SHETTLE (O.D.)

  • 8501 4TH ST N

    ST PETERSBURG, FL 337023110

    Phone: (727) 528-2015

    Fax: (727) 528-2010

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-09-02

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250902001441IOptometryFLTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 33702)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8123178175View full group profile
NameSpecialtyState
O P T O M E T R YFL

Reviews

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Frequently asked questions

What is the registry number for DR. LOGAN SCOTT SHETTLE (O.D.)?
The registry entry for DR. LOGAN SCOTT SHETTLE (O.D.) shows NPI 1417847880.
Is DR. LOGAN SCOTT SHETTLE (O.D.)'s NPI status active today?
Active status means DR. LOGAN SCOTT SHETTLE (O.D.)'s NPI record is not deactivated in the public file.
What type of care does DR. LOGAN SCOTT SHETTLE (O.D.) provide?
DR. LOGAN SCOTT SHETTLE (O.D.)'s profile centers on Optometrist. Clinical services aligned with this taxonomy classification.
Can patients visit DR. LOGAN SCOTT SHETTLE (O.D.) in St Petersburg, Florida?
For routing, start with St Petersburg, Florida for DR. LOGAN SCOTT SHETTLE (O.D.), then verify phone and hours locally.
Who maintains DR. LOGAN SCOTT SHETTLE (O.D.)'s record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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