Provider Demographics
NPI:1679576995
Name:SHAFFER, ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:SHAFFER
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 1:2301 WILTON DR
Mailing Address - Street 2:C1
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1202
Mailing Address - Country:US
Mailing Address - Phone:954-764-6906
Mailing Address - Fax:954-463-7922
Practice Address - Street 1:2301 WILTON DR
Practice Address - Street 2:C1
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1202
Practice Address - Country:US
Practice Address - Phone:954-764-6906
Practice Address - Fax:954-463-7922
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2117152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84233Medicare UPIN
FL19738Medicare ID - Type Unspecified