Provider Demographics
NPI:1801963525
Name:SHEPLAN, EDWARD CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CHARLES
Last Name:SHEPLAN
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 1:1601 RINEHART RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7392
Mailing Address - Country:US
Mailing Address - Phone:407-328-9696
Mailing Address - Fax:407-321-6142
Practice Address - Street 1:1601 RINEHART RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-7392
Practice Address - Country:US
Practice Address - Phone:407-328-9696
Practice Address - Fax:407-321-6142
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1367152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620770700Medicaid
FLT93860Medicare UPIN
FL620770700Medicaid