Provider Demographics
NPI:1407162852
Name:LOU, SHANAR H (OD)
Entity Type:Individual
Prefix:
First Name:SHANAR
Middle Name:H
Last Name:LOU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHANAR
Other - Middle Name:HAJI SHAH
Other - Last Name:MOHAMMAD LOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7100 SIX FORKS RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6156
Mailing Address - Country:US
Mailing Address - Phone:919-847-0187
Mailing Address - Fax:919-676-2231
Practice Address - Street 1:1001 WIDEWATERS PKWY
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6102
Practice Address - Country:US
Practice Address - Phone:919-861-2020
Practice Address - Fax:919-277-0854
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5915885Medicaid
P01211057OtherRAILROAD MEDICARE
NC0932UOtherNORTH CAROLINA BCBS
NC2484659AMedicare PIN
NC2484659HMedicare PIN
NC2484659KMedicare PIN
NC2484659GMedicare PIN
NC2484659Medicare PIN
NC2484659FMedicare PIN
P01211057OtherRAILROAD MEDICARE
NC2484659CMedicare PIN
NC2484659BMedicare PIN
NC0932UOtherNORTH CAROLINA BCBS
NC2484659EMedicare PIN