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General NPI Number Information
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NPI Number | 1699943688
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Entity Type | Organization
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Legal Business Name | DR TRACEY J SHAFFER, OPTOMETRIST PLC
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 4588 VIRGINIA BEACH BLVD CARE OF SEARS OPTICAL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3004
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Country | US
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Telephone | 757-456-5550
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Fax | 757-456-0091
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Provider Business Mailing Address
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Address Line | 705 ERIK PAUL DR
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City | CHESAPEAKE
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State | VA
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Zip | 23322-3717
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Country | US
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Telephone | 757-456-5550
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Fax | 757-456-0091
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRACEY J SHAFFER
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Credential | OD
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Telephone | 757-456-5550
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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 | 0618000633
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License Number State | VA
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