Provider Demographics
NPI:1760567051
Name:WILLIAM E. SHAW, JR., MD LLC.
Entity Type:Organization
Organization Name:WILLIAM E. SHAW, JR., MD LLC.
Other - Org Name:WILLIAM E. SHAW, JR., MD PLC, D/B/A/ SEESHAW EYECARE AT SAM'S CLUB
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:804-277-4410
Mailing Address - Street 1:P.O. BOX 184
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219
Mailing Address - Country:US
Mailing Address - Phone:804-277-4410
Mailing Address - Fax:
Practice Address - Street 1:114 SOUTHPARK CIRCLE
Practice Address - Street 2:C/O SEARS OPTICAL
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834
Practice Address - Country:US
Practice Address - Phone:804-277-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006304010Medicaid
VA006304010Medicaid
VAF43536Medicare UPIN