Provider Demographics
NPI:1417980541
Name:SHELDON, TODD MICHAEL (OD MBA FAAO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MICHAEL
Last Name:SHELDON
Suffix:
Gender:M
Credentials:OD MBA FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SW INDIAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756
Mailing Address - Country:US
Mailing Address - Phone:541-548-2488
Mailing Address - Fax:541-548-5334
Practice Address - Street 1:1000 SW INDIAN AVENUE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756
Practice Address - Country:US
Practice Address - Phone:541-548-2488
Practice Address - Fax:541-548-5334
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2823T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
831397001OtherBLUE CROSS BLUE SHIELD
OR5092580002Medicare NSC
ORU85325Medicare UPIN
OR5032580003Medicare NSC