MEDICARE: DR. DAVID Y SHIPLEY O.D.

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	OPC 2599	FL
2	152WL0500X	Low Vision Rehabilitation Optometrist	OPC 2599	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578531091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID Y SHIPLEY O.D.

Provider Business Mailing Address
First Line	:	201 SE 15TH TER
Second Line	:	SUITE 102
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4464
Country	:	US
Telephone Number	:	954-428-2002
Fax Number	:	954-427-4614

Provider Business Practice Location Address
First Line	:	201 SE 15TH TER
Second Line	:	SUITE 102
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4464
Country	:	US
Telephone Number	:	954-428-2002
Fax Number	:	954-427-4614

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	11/07/2014

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