Provider Demographics
NPI:1366403974
Name:ADLER, SHEPARD ARNOLD (OD)
Entity type:Individual
Prefix:DR
First Name:SHEPARD
Middle Name:ARNOLD
Last Name:ADLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211092WAYNORTH
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-4325
Mailing Address - Country:US
Mailing Address - Phone:727-398-6945
Mailing Address - Fax:
Practice Address - Street 1:1211092WAYNORTH
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-4325
Practice Address - Country:US
Practice Address - Phone:727-398-6945
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20727Medicare ID - Type Unspecified
FL63737Medicare UPIN