Provider Demographics
NPI:1528039955
Name:SHAW, LEONARD S (OD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:S
Last Name:SHAW
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 1:44 MASON ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570
Mailing Address - Country:US
Mailing Address - Phone:603-752-6211
Mailing Address - Fax:603-752-7645
Practice Address - Street 1:44 MASON ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570
Practice Address - Country:US
Practice Address - Phone:603-752-6211
Practice Address - Fax:603-752-7645
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT584152W00000X
NH0225152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80587867Medicaid
ME108660000Medicaid
ME001300OtherANTHEM
NHNH7867Medicare PIN
NHT25705Medicare UPIN
NH80587867Medicaid
ME001300OtherANTHEM