Active NPI
Dana Lynn Shepard, O.D.
- Optometrist
- Waterbury, CT
National Provider Identifier
1003927856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2198
- Practice address
- 3600 E Main St
Waterbury, CT 06705-3851 - Phone
- (203) 596-0406
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2198 | CT | Primary |
Addresses
Primary practice location
3600 E Main St
Waterbury, CT 06705-3851
Mailing address
22 Russet LN
Southington, CT 06489-1771
Phone (860) 276-0081
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 090002198CT12 | Other | CT | ANTHEM BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002198 | CT | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003927856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 RUSSET LN",
"city": "SOUTHINGTON",
"state": "CT",
"postal_code": "064891771",
"telephone_number": "860-276-0081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 E MAIN ST",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067053851",
"telephone_number": "203-596-0406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPARD",
"first_name": "DANA",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CT",
"license": "2198",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS",
"identifier": "090002198CT12",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.