Provider Demographics
NPI:1598288565
Name:SHAFFER, LAUREN MARJORIE (OD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARJORIE
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 1:701 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3804
Mailing Address - Country:US
Mailing Address - Phone:810-238-3603
Mailing Address - Fax:810-767-5194
Practice Address - Street 1:701 S BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3804
Practice Address - Country:US
Practice Address - Phone:810-238-3603
Practice Address - Fax:810-767-5194
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003281152W00000X
MI4901005687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901005687OtherSTATE LICENSE