Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1618TX | WA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | WA1618TX | WA |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | WA1618TX | WA |
N | 152WP0200X | Pediatric Optomitrist | WA1618TX | WA |
N | 152WS0006X | Sports Vision | WA1618TX | WA |
N | 152WV0400X | Optomitrist - Vision Therapist | WA1618TX | WA |
N | 152WX0102X | Occupational Vision | WA1618TX | WA |
NPI | 1245349869 |
---|---|
Provider Name | Dr. Steven Dale Shaffer |
First Address | Dupont, WA 98327-8773 |
Second Address | Dupont, WA 98327-8773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 13/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2029387 | (05) | WA |
U32286 | (02) | WA |