Provider Demographics
NPI:1750388153
Name:SHAPIRO, ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:SHAPIRO
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 1:59 MEMORIAL PKWY
Mailing Address - Street 2:P.O. BOX 125
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-1441
Mailing Address - Country:US
Mailing Address - Phone:732-291-4244
Mailing Address - Fax:732-291-4335
Practice Address - Street 1:59 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-1441
Practice Address - Country:US
Practice Address - Phone:732-291-4244
Practice Address - Fax:732-291-4335
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00349900152W00000X
NJ27TO00030200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSH521323Medicare ID - Type UnspecifiedMEDICARE #
NJT7790Medicare UPIN