MEDICARE: DR. MELISSA B SHAFER O.D., F.A.A.O.

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	18002760A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000285712	OTHER	IN	ANTHEM BCBS
2	4813800001	OTHER	IN	REGION B DMERC

General Provider Information

NPI Number	:	1760558084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA B SHAFER O.D., F.A.A.O.

Provider Business Mailing Address
First Line	:	67 E GARNER RD STE 800
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-7609
Country	:	US
Telephone Number	:	317-852-5000
Fax Number	:	317-852-5009

Provider Business Practice Location Address
First Line	:	67 E GARNER RD STE 800
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-7609
Country	:	US
Telephone Number	:	317-852-5000
Fax Number	:	317-852-5009

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	05/15/2011

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