Active NPI
William A Shachtman, M.D.
- Ophthalmology Physician
- Fort Collins, CO
National Provider Identifier
1609872068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 17613
- Practice address
- 1725 E Prospect Road
Fort Collins, CO 80525-1307 - Phone
- (970) 221-2222
- Fax
- (970) 221-4286
- NPI assigned
- Jun 21, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 17613 | CO | Primary |
Addresses
Primary practice location
1725 E Prospect Road
Fort Collins, CO 80525-1307
Mailing address
1725 E Prospect Road
Fort Collins, CO 80525-1307
Phone (970) 221-2222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01176130 | Medicaid | CO |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17613 | CO | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193529600000",
"number": "1609872068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1725 E PROSPECT ROAD",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805251307",
"telephone_number": "970-221-2222",
"fax_number": "970-221-4286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1725 E PROSPECT ROAD",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805251307",
"telephone_number": "970-221-2222",
"fax_number": "970-221-4286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACHTMAN",
"first_name": "WILLIAM",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-21",
"last_updated": "2007-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "CO",
"license": "17613",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01176130",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.