Provider Demographics
NPI:1538457072
Name:SHEPHERD, TERI (OD)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 NW 128TH ST
Mailing Address - Street 2:STE 150
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7433
Mailing Address - Country:US
Mailing Address - Phone:515-223-9595
Mailing Address - Fax:515-223-9792
Practice Address - Street 1:2699 86TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4309
Practice Address - Country:US
Practice Address - Phone:515-270-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002524152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist