Provider Demographics
NPI:1851564017
Name:SHAFFER EYE CLINIC
Entity Type:Organization
Organization Name:SHAFFER EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-428-4420
Mailing Address - Street 1:5203 HIGHWAY 11 N
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39437-5001
Mailing Address - Country:US
Mailing Address - Phone:601-428-4420
Mailing Address - Fax:601-425-9018
Practice Address - Street 1:5203 HIGHWAY 11 N
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39437-5001
Practice Address - Country:US
Practice Address - Phone:601-428-4420
Practice Address - Fax:601-425-9018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS695261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016268Medicaid