Provider Demographics
NPI:1649231598
Name:DANIEL, RICHARD SHAFFER (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SHAFFER
Last Name:DANIEL
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 1:161 WESTWOOD SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1521
Mailing Address - Country:US
Mailing Address - Phone:910-864-6070
Mailing Address - Fax:910-864-4036
Practice Address - Street 1:161 WESTWOOD SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1521
Practice Address - Country:US
Practice Address - Phone:910-864-6070
Practice Address - Fax:910-864-4036
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1115152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909220Medicaid
NC09220OtherBLUE CROSS BLUE SHIELD
NC8909220Medicaid
NC1188180001Medicare NSC