Provider Demographics
NPI:1588663702
Name:SHEPPARD, JOHN DANIEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DANIEL
Last Name:SHEPPARD
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:241 CORPORATE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4975
Mailing Address - Country:US
Mailing Address - Phone:757-622-2200
Mailing Address - Fax:757-622-4866
Practice Address - Street 1:241 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4954
Practice Address - Country:US
Practice Address - Phone:757-622-2200
Practice Address - Fax:757-622-4866
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043383207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1295959OtherCIGNA
VA180015712OtherRR MEDICARE
VA15830OtherOPTIMA
VA332514OtherANTHEM BCBS
NC6906436Medicaid
VA1588663702OtherVIRGINIA PREMIER
NC6906436Medicaid
D80392Medicare UPIN