Provider Demographics
NPI:1912415563
Name:DR. SHANE F. LASTER P.A.
Entity Type:Organization
Organization Name:DR. SHANE F. LASTER P.A.
Other - Org Name:LASTER EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:F
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-242-2020
Mailing Address - Street 1:8500 S 36TH TER
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8880
Mailing Address - Country:US
Mailing Address - Phone:479-242-2020
Mailing Address - Fax:479-242-1919
Practice Address - Street 1:8500 S 36TH TER
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8880
Practice Address - Country:US
Practice Address - Phone:479-242-2020
Practice Address - Fax:479-242-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200749530AMedicaid
AR225442722Medicaid