Healthcare Provider Details

I. General information

NPI: 1407824261
Provider Name (Legal Business Name): DAVID L SHAFF OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 W COMMERCIAL ST
EAST ROCHESTER NY
14445-2276
US

IV. Provider business mailing address

533 W COMMERCIAL ST
EAST ROCHESTER NY
14445-2276
US

V. Phone/Fax

Practice location:
  • Phone: 585-586-6882
  • Fax:
Mailing address:
  • Phone: 585-586-6882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV003038
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: