NPIMap

Individual provider Active NPI

W. Cory Shaffer, O.D.

  • Optometrist
  • Plainfield, IN
National Provider Identifier
1154335271
Registry record updated Aug 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18001624A Issued in IN
Practice address
1855 Stafford Rd
Plainfield, IN 46168-2338
Phone
(317) 839-2368
Fax
(317) 839-1267
NPI assigned
Jul 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2011

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18001624A IN Primary
Corneal and Contact Management Optometrist 152WC0802X 18001624A IN
Low Vision Rehabilitation Optometrist 152WL0500X 18001624A IN
Pediatric Optometrist 152WP0200X 18001624A IN
Sports Vision Optometrist 152WS0006X 18001624A IN
Vision Therapy Optometrist 152WV0400X 18001624A IN
Occupational Vision Optometrist 152WX0102X 18001624A IN

Addresses

Primary practice location

1855 Stafford Rd
Plainfield, IN 46168-2338

Mailing address

5290 Breccia Dr
Plainfield, IN 46168-9194
Phone (317) 839-0280

Other identifiers 2

IdentifierTypeStateIssuer
000000083758OtherINANTHEM
11480263OtherINCAQH

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

LicenseStateTypeSpecialty
18001624AINMDPediatric Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Plainfield Eye Care PC Optometrist PastSince Jul 1, 1977 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312416000000",
    "number": "1154335271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5290 BRECCIA DR",
            "city": "PLAINFIELD",
            "state": "IN",
            "postal_code": "461689194",
            "telephone_number": "317-839-0280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 STAFFORD RD",
            "city": "PLAINFIELD",
            "state": "IN",
            "postal_code": "461682338",
            "telephone_number": "317-839-2368",
            "fax_number": "317-839-1267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "W.",
        "middle_name": "CORY",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2011-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001624A",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "IN",
            "license": "18001624A",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "IN",
            "license": "18001624A",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "IN",
            "license": "18001624A",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "IN",
            "license": "18001624A",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "IN",
            "license": "18001624A",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "IN",
            "license": "18001624A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000083758",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11480263",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainfield, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.