MEDICARE: JARED ALLEN SHAVER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1706	AZ

General Provider Information

NPI Number	:	1316178973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED ALLEN SHAVER O.D.

Provider Business Mailing Address
First Line	:	21321 E OCOTILLO RD STE 105
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-5993
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21321 E OCOTILLO RD STE 105
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-5993
Country	:	US
Telephone Number	:	480-656-7739
Fax Number	:	480-656-1637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	06/25/2026

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