Provider Demographics
NPI:1972789071
Name:SHAW OPTICIANS LLC
Entity Type:Organization
Organization Name:SHAW OPTICIANS LLC
Other - Org Name:SHAW OPTICIANS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:VERACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-544-3430
Mailing Address - Street 1:1295 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2731
Mailing Address - Country:US
Mailing Address - Phone:585-544-3430
Mailing Address - Fax:585-544-3473
Practice Address - Street 1:1295 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2731
Practice Address - Country:US
Practice Address - Phone:585-544-3430
Practice Address - Fax:585-544-3473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC002739-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00450564Medicaid
NY6088040001Medicare NSC