Provider Demographics
NPI:1295000693
Name:ALAN L. SHABO M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ALAN L. SHABO M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN&SURGEON/OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SHABO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-824-9661
Mailing Address - Street 1:10921 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3906
Mailing Address - Country:US
Mailing Address - Phone:310-824-9661
Mailing Address - Fax:310-824-9867
Practice Address - Street 1:10921 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3906
Practice Address - Country:US
Practice Address - Phone:310-824-9661
Practice Address - Fax:310-824-9867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23893207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23893OtherPTAN
01112710004286-001OtherCCN
CAA23747Medicare UPIN