Individual
W. CORY SHAFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1855 STAFFORD RD, PLAINFIELD, IN 46168-2338
(317) 839-2368
(317) 839-1267
Mailing address
5290 BRECCIA DR, PLAINFIELD, IN 46168-9194
(317) 839-0280
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001624A
IN
152WC0802X
Corneal and Contact Management Optometrist
18001624A
IN
152WL0500X
Low Vision Rehabilitation Optometrist
18001624A
IN
152WP0200X
Pediatric Optometrist
18001624A
IN
152WS0006X
Sports Vision Optometrist
18001624A
IN
152WV0400X
Vision Therapy Optometrist
18001624A
IN
152WX0102X
Occupational Vision Optometrist
18001624A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000083758
ANTHEM
IN
01
—
11480263
CAQH
IN
Enumeration date
07/27/2006
Last updated
08/04/2011
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