Provider Demographics
NPI:1699920793
Name:DR EDWARD C SHEPLAN PA
Entity type:Organization
Organization Name:DR EDWARD C SHEPLAN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHEPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-328-9696
Mailing Address - Street 1:1601 RINEHART RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7392
Mailing Address - Country:US
Mailing Address - Phone:407-328-9696
Mailing Address - Fax:407-321-6142
Practice Address - Street 1:1601 RINEHART RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-7392
Practice Address - Country:US
Practice Address - Phone:407-328-9696
Practice Address - Fax:407-321-6142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1367152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty