MEDICARE: DR. JOSEPH LEON SHETLER OD

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	939	NE
2	152W00000X	Optometrist	621	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410017859	OTHER	NE	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4993075	OTHER	SD	WELLMARK BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	06923	OTHER	NE	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952362139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH LEON SHETLER OD

Provider Business Mailing Address
First Line	:	112 N MAIN
Second Line	:	GORDON VISION CENTER
City	:	GORDON
State	:	NE
Zip	:	69343-1524
Country	:	US
Telephone Number	:	308-282-0820
Fax Number	:	308-282-0833

Provider Business Practice Location Address
First Line	:	112 N MAIN
Second Line	:	GORDON VISION CENTER
City	:	GORDON
State	:	NE
Zip	:	69343-1524
Country	:	US
Telephone Number	:	308-282-0820
Fax Number	:	308-282-0833

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	07/15/2010

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Directions to “ DR. JOSEPH LEON SHETLER OD” Practice Location

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