Provider Demographics
NPI:1659494102
Name:JEFFREY D. SHEARER, O.D., P.A
Entity Type:Organization
Organization Name:JEFFREY D. SHEARER, O.D., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EYE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHEARER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-641-3937
Mailing Address - Street 1:9978 OLD BAYMEADOWS RD
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7905
Mailing Address - Country:US
Mailing Address - Phone:904-641-3937
Mailing Address - Fax:904-641-0159
Practice Address - Street 1:9978 OLD BAYMEADOWS RD
Practice Address - Street 2:SUITE # 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7905
Practice Address - Country:US
Practice Address - Phone:904-641-3937
Practice Address - Fax:904-641-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2119152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T84247Medicare UPIN
FL19454Medicare ID - Type Unspecified