Provider Demographics
NPI:1639148513
Name:SHEPARD, GERALD HENRY (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:HENRY
Last Name:SHEPARD
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 1:90161 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9424
Mailing Address - Country:US
Mailing Address - Phone:541-461-4948
Mailing Address - Fax:
Practice Address - Street 1:4550 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5414
Practice Address - Country:US
Practice Address - Phone:541-344-3440
Practice Address - Fax:541-344-3442
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2030AT152W00000X
CA9089152W00000X
HI277152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU26466Medicare UPIN