MEDICARE: DR TRACEY J SHAFFER, OPTOMETRIST PLC

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	0618000633	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699943688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR TRACEY J SHAFFER, OPTOMETRIST PLC

Provider Business Mailing Address
First Line	:	705 ERIK PAUL DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-3717
Country	:	US
Telephone Number	:	757-456-5550
Fax Number	:	757-456-0091

Provider Business Practice Location Address
First Line	:	4588 VIRGINIA BEACH BLVD
Second Line	:	CARE OF SEARS OPTICAL
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3004
Country	:	US
Telephone Number	:	757-456-5550
Fax Number	:	757-456-0091

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TRACEY J SHAFFER
Credential	:	OD
Telephone Number	:	757-456-5550

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	09/08/2010

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