Provider Demographics
NPI:1952362139
Name:SHETLER, JOSEPH LEON (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEON
Last Name:SHETLER
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 1:112 N MAIN
Mailing Address - Street 2:GORDON VISION CENTER
Mailing Address - City:GORDON
Mailing Address - State:NE
Mailing Address - Zip Code:69343-1524
Mailing Address - Country:US
Mailing Address - Phone:308-282-0820
Mailing Address - Fax:308-282-0833
Practice Address - Street 1:112 N MAIN
Practice Address - Street 2:GORDON VISION CENTER
Practice Address - City:GORDON
Practice Address - State:NE
Practice Address - Zip Code:69343-1524
Practice Address - Country:US
Practice Address - Phone:308-282-0820
Practice Address - Fax:308-282-0833
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE939152W00000X
SD621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE410017859OtherRR MEDICARE
SD4993075OtherWELLMARK BCBS
SD9202142Medicaid
NE06923OtherBCBS
SD9202140Medicaid
SD9202143Medicaid
SD9202140Medicaid
NE410017859OtherRR MEDICARE
NE06923OtherBCBS
SD9202143Medicaid
SD9202142Medicaid
SD0324130005Medicare NSC