Provider Demographics
NPI:1992907349
Name:STEVEN & DONNA SHEPARD
Entity type:Organization
Organization Name:STEVEN & DONNA SHEPARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:T
Authorized Official - Last Name:SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-343-0406
Mailing Address - Street 1:11410 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 3201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4097
Mailing Address - Country:US
Mailing Address - Phone:512-343-0406
Mailing Address - Fax:512-343-1093
Practice Address - Street 1:11410 JOLLYVILLE RD
Practice Address - Street 2:SUITE 3201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4097
Practice Address - Country:US
Practice Address - Phone:512-343-0406
Practice Address - Fax:512-343-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3985T AND 3986T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E09MOtherBCBS
TX00E09MOtherBCBS
TX00394TMedicare ID - Type UnspecifiedMEDICARE
U11198Medicare UPIN