Paul Shepherd, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

026101-OD00001619 Issued in WA

Practice address

2726 Griffin Ave Ste B
Enumclaw, WA 98022-2362

Phone

(360) 825-3000

Fax

(360) 825-8408

NPI assigned

Jun 7, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Enumclaw Family Optometry Clinic PS

  • Optometrist
  • Enumclaw, WA
  • NPI 1841232121
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1093918013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2726 GRIFFIN AVE STE B",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980222362",
            "telephone_number": "360-825-3000",
            "fax_number": "360-825-8408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2726 GRIFFIN AVE STE B",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980222362",
            "telephone_number": "360-825-3000",
            "fax_number": "360-825-8408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "PAUL",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-07",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "026101-OD00001619",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1816",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "SH2147",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2016699",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark A Seaburg, OD
• Sean Monaghan DMD PLLC
• Senior Care Specialists LLC
• Kelly Melissa Sennott, COTA
• Alexander Shepherd, OD
• Inna Shulyak
• June I Siapco, PTA
• Simple Medical, LLC
• Brent Arnold Skovmand, DDS
• Gary Dean Smith, DC

• Optometrist in Enumclaw, WA
• Providers in Enumclaw, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.