Shaun Stuart Shafer, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

5934A Issued in WY

Practice address

204 McCollum Dr
Suite 201
Laramie, WY 82070-5103

Phone

(307) 742-2131

Fax

(307) 742-2134

NPI assigned

Aug 11, 2005

Reactivated

Mar 29, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Tri State Eye Ophthalmology of Middletown PC

  • Specialist
  • Middletown, NY
  • NPI 1053430256
  NPD (past)
• Tri-State Eye Inc

  • Ophthalmology Physician
  • Milford, PA
  • NPI 1255450581
  NPD (past)

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576713600000",
    "number": "1730181561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 MCCOLLUM DR",
            "address_2": "SUITE 201",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705103",
            "telephone_number": "307-742-2131",
            "fax_number": "307-742-2134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MCCOLLUM DR",
            "address_2": "SUITE 201",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705103",
            "telephone_number": "307-742-2131",
            "fax_number": "307-742-2134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFER",
        "first_name": "SHAUN",
        "middle_name": "STUART",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "deactivation_date": "2006-03-22",
        "reactivation_date": "2006-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1100X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Ophthalmic",
            "state": "WY",
            "license": "5934A",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WY",
            "license": "5934A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118240400",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180046305",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Serrell, PPC-1687
• Natalie Sertic
• Sawyer Seville
• Gretchen Mary Sewczak-Claude, PT, DPT
• Catherine A Shafer, COTA
• Joseph Julian Shahidi
• Seyyed Sharifi
• Hannah Sharpston
• Shaun S Shafer MD PC
• Chelsea Shaw

• Ophthalmology Physician in Laramie, WY
• Providers in Laramie, WY by specialty
• Ophthalmology Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; 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.