Provider Demographics
NPI:1376787226
Name:DR. GARY SHEPARD, PC
Entity Type:Organization
Organization Name:DR. GARY SHEPARD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-640-0116
Mailing Address - Street 1:2035 WHISKEY RD
Mailing Address - Street 2:WALMART VISION CENTER
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7956
Mailing Address - Country:US
Mailing Address - Phone:803-643-3785
Mailing Address - Fax:803-648-2440
Practice Address - Street 1:2035 WHISKEY RD
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7956
Practice Address - Country:US
Practice Address - Phone:803-643-3785
Practice Address - Fax:803-648-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1012152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty