MEDICARE: MELISSA ANNA SHAFFER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3125	MN

General Provider Information

NPI Number	:	1285833624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANNA SHAFFER O.D.

Provider Business Mailing Address
First Line	:	4118 W DIVISION ST
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-3706
Country	:	US
Telephone Number	:	320-251-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	4118 W DIVISION ST
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-3706
Country	:	US
Telephone Number	:	320-251-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	11/29/2016

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