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NPI Code Detail

MEDICARE: DR. GERALD HENRY SHEPARD O.D.

MEDICARE: DR. GERALD HENRY SHEPARD 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
1152W00000XOptometrist2030ATOR
2152W00000XOptometrist9089CA
3152W00000XOptometrist277HI

General Provider Information

NPI Number : 1639148513
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GERALD HENRY SHEPARD O.D.
Provider Business Mailing Address
First Line : 90161 LAKEVIEW DR
Second Line :
City : EUGENE
State : OR
Zip : 97402-9424
Country : US
Telephone Number : 541-461-4948
Fax Number :
Provider Business Practice Location Address
First Line : 4550 W 11TH AVE
Second Line :
City : EUGENE
State : OR
Zip : 97402-5414
Country : US
Telephone Number : 541-344-3440
Fax Number : 541-344-3442
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 04/12/2026

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