Provider Demographics
NPI:1003009499
Name:ROGER F. SHAW, III APMC
Entity Type:Organization
Organization Name:ROGER F. SHAW, III APMC
Other - Org Name:SOUTHERN EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:FALCONER
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:225-923-0909
Mailing Address - Street 1:7587 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8308
Mailing Address - Country:US
Mailing Address - Phone:225-923-0909
Mailing Address - Fax:225-923-0445
Practice Address - Street 1:7587 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8308
Practice Address - Country:US
Practice Address - Phone:225-923-0909
Practice Address - Fax:225-923-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA754-055T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5D147Medicare PIN