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General NPI Number Information
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NPI Number | 1003927856
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Entity Type | Individual
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Provider Name | DANA LYNN SHEPARD O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3600 E MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06705-3851
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Country | US
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Telephone | 203-596-0406
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Fax |
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Provider Business Mailing Address
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Address Line | 22 RUSSET LN
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City | SOUTHINGTON
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State | CT
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Zip | 06489-1771
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Country | US
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Telephone | 860-276-0081
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2198
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License Number State | CT
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