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General NPI Number Information
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NPI Number | 1376787226
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Entity Type | Organization
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Legal Business Name | DR. GARY SHEPARD, PC
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 2035 WHISKEY RD WALMART VISION CENTER
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City | AIKEN
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State | SC
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Zip | 29803-7956
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Country | US
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Telephone | 803-643-3785
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Fax | 803-648-2440
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Provider Business Mailing Address
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Address Line | 2035 WHISKEY RD WALMART VISION CENTER
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City | AIKEN
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State | SC
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Zip | 29803-7956
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Country | US
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Telephone | 803-643-3785
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Fax | 803-648-2440
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY SHEPARD
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Credential | O.D.
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Telephone | 803-640-0116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 1012
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1012
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License Number State | SC
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