Provider Demographics
NPI:1275590291
Name:SHAFER, PATRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:SHAFER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-4989
Mailing Address - Country:US
Mailing Address - Phone:270-889-9006
Mailing Address - Fax:270-889-0692
Practice Address - Street 1:300 CLINIC DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4989
Practice Address - Country:US
Practice Address - Phone:270-889-9006
Practice Address - Fax:270-889-0692
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY947DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9242201Medicare ID - Type Unspecified