Provider Demographics
NPI:1568446417
Name:SHEPARDSON, STANLEY O (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:O
Last Name:SHEPARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 NE DOCTORS DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6324
Mailing Address - Country:US
Mailing Address - Phone:541-389-3166
Mailing Address - Fax:
Practice Address - Street 1:2275 NE DOCTORS DR
Practice Address - Street 2:SUITE 6
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6324
Practice Address - Country:US
Practice Address - Phone:541-389-3166
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07630207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORF64946Medicare UPIN
OR110894Medicare ID - Type Unspecified