Provider Demographics
NPI:1164673505
Name:SHAW, ANN HARDIN (OD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:HARDIN
Last Name:SHAW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2262 MYRTLEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2878
Mailing Address - Country:US
Mailing Address - Phone:225-379-3529
Mailing Address - Fax:225-687-2000
Practice Address - Street 1:23855 EDEN ST
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-3315
Practice Address - Country:US
Practice Address - Phone:225-687-2026
Practice Address - Fax:225-687-2000
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1555-587T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist