Provider Demographics
NPI:1578531091
Name:SHIPLEY, DAVID Y (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:Y
Last Name:SHIPLEY
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 1:201 SE 15TH TER
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4464
Mailing Address - Country:US
Mailing Address - Phone:954-428-2002
Mailing Address - Fax:954-427-4614
Practice Address - Street 1:201 SE 15TH TER
Practice Address - Street 2:SUITE 102
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4464
Practice Address - Country:US
Practice Address - Phone:954-428-2002
Practice Address - Fax:954-427-4614
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2599152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078954201Medicaid
FL078954201Medicaid
FL5218620001Medicare NSC
FL20385Medicare ID - Type Unspecified