Provider Demographics
NPI:1558478461
Name:SHAFFER, SHELDA MAE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHELDA
Middle Name:MAE
Last Name:SHAFFER
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 1:3225 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-6221
Mailing Address - Country:US
Mailing Address - Phone:325-691-0101
Mailing Address - Fax:325-691-8950
Practice Address - Street 1:3225 S 27TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-6221
Practice Address - Country:US
Practice Address - Phone:325-691-0101
Practice Address - Fax:325-691-8950
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06465TG152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A003OtherHUMANA/TRICARE
TX81011QOtherBLUE CROSS BLUE SHIELD
TX8C0209Medicare ID - Type Unspecified
TX81011QOtherBLUE CROSS BLUE SHIELD