Active NPI
Denise Q. Shepard, O.D.
- Optometrist
- Fort Oglethorpe, GA
National Provider Identifier
1184650988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 893
- Practice address
- 1895 Battlefield Pkwy
Ft Oglethorpe, GA 30742-4021 - Phone
- (706) 861-7166
- Fax
- (706) 861-1799
- NPI assigned
- Jun 23, 2006
- Last updated
- Feb 17, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 893 | GA | Primary |
| Optometrist | 152W00000X | 735 | TN |
Addresses
Primary practice location
1895 Battlefield Pkwy
Ft Oglethorpe, GA 30742-4021
Mailing address
1895 Battlefield Pkwy
Ft Oglethorpe, GA 30742-4021
Phone (706) 861-7166
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000173788 | Medicaid | TN | |
| 00394677A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 893 | GA | MD | Optometrist |
| 735 | TN | MD | Speech-Language Assistant |
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234828800000",
"number": "1184650988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1895 BATTLEFIELD PKWY",
"city": "FT OGLETHORPE",
"state": "GA",
"postal_code": "307424021",
"telephone_number": "706-861-7166",
"fax_number": "706-861-1799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1895 BATTLEFIELD PKWY",
"city": "FT OGLETHORPE",
"state": "GA",
"postal_code": "307424021",
"telephone_number": "706-861-7166",
"fax_number": "706-861-1799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPARD",
"first_name": "DENISE",
"middle_name": "Q.",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-23",
"last_updated": "2009-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "GA",
"license": "893",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TN",
"license": "735",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000173788",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00394677A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Oglethorpe, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2009; 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.