Provider Demographics
NPI:1982801957
Name:SHAFFER, BRADLEY ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ANDREW
Last Name:SHAFFER
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 1:225 MAIN ST
Mailing Address - Street 2:#200
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-1329
Mailing Address - Country:US
Mailing Address - Phone:423-779-7712
Mailing Address - Fax:
Practice Address - Street 1:225 MAIN ST
Practice Address - Street 2:#200
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1329
Practice Address - Country:US
Practice Address - Phone:423-779-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN2767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist