Provider Demographics
NPI:1760558084
Name:SHAFER, MELISSA B (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:B
Last Name:SHAFER
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 E GARNER RD STE 800
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7609
Mailing Address - Country:US
Mailing Address - Phone:317-852-5000
Mailing Address - Fax:317-852-5009
Practice Address - Street 1:67 E GARNER RD STE 800
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7609
Practice Address - Country:US
Practice Address - Phone:317-852-5000
Practice Address - Fax:317-852-5009
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002760A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000285712OtherANTHEM BCBS
IN4813800001OtherREGION B DMERC
IN000000285712OtherANTHEM BCBS
INP00620434Medicare PIN
IN4813800001OtherREGION B DMERC
IN202850Medicare ID - Type UnspecifiedMEDICARE #