Healthcare Provider Details

I. General information

NPI: 1336070150
Provider Name (Legal Business Name): NATHAN SHAFER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 E GARNER RD STE 800
BROWNSBURG IN
46112-7609
US

IV. Provider business mailing address

67 E GARNER RD STE 800
BROWNSBURG IN
46112-7609
US

V. Phone/Fax

Practice location:
  • Phone: 317-852-5000
  • Fax: 317-852-5009
Mailing address:
  • Phone: 317-852-5000
  • Fax: 317-852-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004657A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: