Healthcare Provider Details

I. General information

NPI: 1174521686
Provider Name (Legal Business Name): JAMES W SHAVER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S MAIN ST
LANDIS NC
28088
US

IV. Provider business mailing address

PO BOX 8147
LANDIS NC
28088-8147
US

V. Phone/Fax

Practice location:
  • Phone: 704-857-2238
  • Fax: 704-857-2239
Mailing address:
  • Phone: 704-857-2238
  • Fax: 704-857-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1320
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: