Individual
DR. DANA LYNN SHEPARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
3600 E MAIN ST, WATERBURY, CT 06705-3851
(203) 596-0406
Mailing address
22 RUSSET LN, SOUTHINGTON, CT 06489-1771
(860) 276-0081
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2198
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090002198CT12
ANTHEM BLUE CROSS
CT
Enumeration date
08/31/2006
Last updated
07/08/2007
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