Provider Demographics
NPI:1871246298
Name:SHAFFER VISION INC.
Entity type:Organization
Organization Name:SHAFFER VISION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-487-6363
Mailing Address - Street 1:340 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7043
Mailing Address - Country:US
Mailing Address - Phone:805-487-6363
Mailing Address - Fax:
Practice Address - Street 1:340 S 5TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7043
Practice Address - Country:US
Practice Address - Phone:805-487-6363
Practice Address - Fax:805-486-9698
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAFFER VISION INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457451031OtherNPI
CASD0057742Medicaid