Provider Demographics
NPI:1316178973
Name:SHAVER, JARED ALLEN (OD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:ALLEN
Last Name:SHAVER
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 1:18722 E SEAGULL DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5144
Mailing Address - Country:US
Mailing Address - Phone:480-319-5520
Mailing Address - Fax:
Practice Address - Street 1:21321 E OCOTILLO RD STE 105
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5993
Practice Address - Country:US
Practice Address - Phone:480-656-7739
Practice Address - Fax:480-656-1637
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist