Provider Demographics
NPI:1619991478
Name:KERSHAW, JAMES W (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:KERSHAW
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 1:26777 LORAIN RD STE 203
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3226
Mailing Address - Country:US
Mailing Address - Phone:440-333-3060
Mailing Address - Fax:
Practice Address - Street 1:26777 LORAIN RD STE 203
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3226
Practice Address - Country:US
Practice Address - Phone:440-333-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3130 T510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000152225OtherANTHEM BLUE CROSS & BLUE
OH7230742OtherAETNA
OH341178696-00OtherBWC
OH6561961OtherCIGNA
OH410047174OtherRAILROAD MEDICARE
OH6561961OtherCIGNA
OHT47012Medicare UPIN