Provider Demographics
NPI:1275082687
Name:DR. JEFFERY SHIAU OPTOMETRIST, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR. JEFFERY SHIAU OPTOMETRIST, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIAU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-282-3115
Mailing Address - Street 1:2 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3552
Mailing Address - Country:US
Mailing Address - Phone:626-282-3115
Mailing Address - Fax:626-282-3463
Practice Address - Street 1:2 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3552
Practice Address - Country:US
Practice Address - Phone:626-282-3115
Practice Address - Fax:626-282-3463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty