Provider Demographics
NPI:1558435099
Name:JEFFREY T SHAVER PC
Entity Type:Organization
Organization Name:JEFFREY T SHAVER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:405-834-0532
Mailing Address - Street 1:3431 S BOULEVARD ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5475
Mailing Address - Country:US
Mailing Address - Phone:405-562-2036
Mailing Address - Fax:
Practice Address - Street 1:3840 S BOULEVARD
Practice Address - Street 2:SUITE 101
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5478
Practice Address - Country:US
Practice Address - Phone:405-471-5252
Practice Address - Fax:405-726-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20009910AMedicaid
OKDF7884OtherMEDICARE RAILROAD
OK900522544Medicare PIN