Provider Demographics
NPI:1457451031
Name:SHAFFER, WILLIAM JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:SHAFFER
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 1:340 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7043
Mailing Address - Country:US
Mailing Address - Phone:805-487-6363
Mailing Address - Fax:805-486-9698
Practice Address - Street 1:340 S 5TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7043
Practice Address - Country:US
Practice Address - Phone:805-487-6363
Practice Address - Fax:805-486-9698
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5774T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0057742Medicaid
CAOP5774Medicare PIN
CASD0057742Medicaid
CA000070037Medicare ID - Type UnspecifiedSUBMITTER NUMBER
CA0961940001Medicare NSC