Healthcare Provider Details

I. General information

NPI: 1457489916
Provider Name (Legal Business Name): HUNT & SHAW, A PROFESSIONAL OPTOMETRIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7965 HIGHWAY 9
BEN LOMOND CA
95005-9703
US

IV. Provider business mailing address

7965 HIGHWAY 9
BEN LOMOND CA
95005-9703
US

V. Phone/Fax

Practice location:
  • Phone: 831-336-2279
  • Fax:
Mailing address:
  • Phone: 831-336-2279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC D. SHAW
Title or Position: CEO
Credential: OD
Phone: 831-336-2279