Provider Demographics
NPI:1134534233
Name:SHEPPARD, NATALYA (OD)
Entity type:Individual
Prefix:DR
First Name:NATALYA
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NATALYA
Other - Middle Name:
Other - Last Name:ARCHULETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19306 113TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-0202
Mailing Address - Country:US
Mailing Address - Phone:720-839-3999
Mailing Address - Fax:
Practice Address - Street 1:2040 148TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5527
Practice Address - Country:US
Practice Address - Phone:720-839-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008168152W00000X
NC2684152W00000X
WA60714399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist