Provider Demographics
NPI:1881633717
Name:SCHAFFER, SHANNON C (OD)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:C
Last Name:SCHAFFER
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 1:16920 WRIGHT PLZ
Mailing Address - Street 2:SUITE 122
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4660
Mailing Address - Country:US
Mailing Address - Phone:402-898-3937
Mailing Address - Fax:402-333-3885
Practice Address - Street 1:16920 WRIGHT PLZ
Practice Address - Street 2:SUITE 122
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4660
Practice Address - Country:US
Practice Address - Phone:402-898-3937
Practice Address - Fax:402-333-3885
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1016152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE410039188OtherRR MEDICARE
NE10025388500Medicaid
NE10025583800Medicaid
NE10025388400Medicaid
NE36336OtherBCBS
NE903741OtherSHARE ADVANTAGE
NE28376Medicare UPIN
NE10025583800Medicaid
NE4589570001Medicare NSC