Provider Demographics
NPI:1841661394
Name:DENNIS D SHEPARD MD INC
Entity type:Organization
Organization Name:DENNIS D SHEPARD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANZISKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-614-7591
Mailing Address - Street 1:1418 E MAIN ST STE 130
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4836
Mailing Address - Country:US
Mailing Address - Phone:805-614-7591
Mailing Address - Fax:805-614-7592
Practice Address - Street 1:1418 E MAIN ST STE 130
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4836
Practice Address - Country:US
Practice Address - Phone:805-614-7591
Practice Address - Fax:805-614-7592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69671207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty