Provider Demographics
NPI:1275625139
Name:SHAFMAN, THEODORE F (OD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:F
Last Name:SHAFMAN
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 1:1700 WHITEHORSE HAMILTON SQUARE RD. SUITE A-1
Mailing Address - Street 2:CAMPUS EYE GROUP
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3537
Mailing Address - Country:US
Mailing Address - Phone:609-587-2020
Mailing Address - Fax:
Practice Address - Street 1:1700 WHITEHORSE HAMILTON SQUARE RD
Practice Address - Street 2:CAMPUS EYE GROUP SUITE A-1
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-3536
Practice Address - Country:US
Practice Address - Phone:609-587-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00359100152W00000X
PAOE005047P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1728903-01Medicaid
NJ1728903-01Medicaid
NJ138840YJCXMedicare PIN
NJU24921Medicare UPIN