Philip Shaffer, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT003486 Issued in GA

Practice address

1230 Bald Ridge Marina Rd Ste 100
Cumming, GA 30041-7950

Phone

(770) 292-1999

NPI assigned

Oct 5, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN, GA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pshaffer@esp.intellechartdirect.net

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.

• Gainesville Eye Associates LLC

  • Ophthalmology Physician
  • Gainesville, GA
  • NPI 1285617647

  Optometrist

  Medicare reassignment NPD
• First Impressions Optometric Associates, LLC

  • Optometrist
  • Bloomington, IN
  • NPI 1083366363
  Medicare reassignment NPD
• Gainesville Eye Associates LLC

  dba North Georgia Eye Associates

  • Ophthalmology Physician
  • Braselton, GA
  • NPI 1821875774

  Optometrist

  NPD
• First Impressions Optometric Associates, LLC

  • Eyewear Supplier
  • Highland, IN
  • NPI 1942960539

  Optometrist

  NPD
• Loman Eye Care, Inc

  • Optometrist
  • Carmel, IN
  • NPI 1609992767
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1349395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1205188844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 BALD RIDGE MARINA RD STE 100",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 BALD RIDGE MARINA RD STE 100",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417950",
            "telephone_number": "770-292-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-05",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003734A",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathan Milan Setka
• Kimberly Castro Seymour, MSCM
• Shannon Seymour
• SGP Services LLC
• Judy Shafer, BCND
• Dhaval Shrikant Shah, MD
• Monal Khansaheb Shah, M.D.
• Namrata Dhiren Shah, M.D.
• Satyam Jethalal Shah, RPT
• Sunay Shah, MD

• Optometrist in Cumming, GA
• Providers in Cumming, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.