Provider Demographics
NPI:1043209612
Name:SHEPARD, DONNA G (OD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:G
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:11410 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 3201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4097
Mailing Address - Country:US
Mailing Address - Phone:512-343-0406
Mailing Address - Fax:512-343-1093
Practice Address - Street 1:11410 JOLLYVILLE RD
Practice Address - Street 2:SUITE 3201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4097
Practice Address - Country:US
Practice Address - Phone:512-343-0406
Practice Address - Fax:512-343-1093
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2015-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX3985T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU11198Medicare UPIN
TXU11198Medicare UPIN