Provider Demographics
NPI:1679611446
Name:SHAFFER, CURTIS J (OD)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:J
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-271-2020
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:7148 U S HIGHWAY 98
Practice Address - Street 2:SUITE 201
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8577
Practice Address - Country:US
Practice Address - Phone:601-271-2020
Practice Address - Fax:601-264-2660
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880229Medicaid
MS09016268Medicaid
MSP01353377OtherRAILROAD MEDICARE
MS09016268Medicaid