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General NPI Number Information
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NPI Number | 1013928480
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Entity Type | Individual
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Provider Name | JOHN ROBERT SHAW O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 5821 W CENTRAL AVE
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City | TOLEDO
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State | OH
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Zip | 43615-1403
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Country | US
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Telephone | 419-536-9294
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Fax | 419-536-9340
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Provider Business Mailing Address
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Address Line | 6020 W BANCROFT ST # 352215
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City | TOLEDO
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State | OH
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Zip | 43615-3200
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Country | US
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Telephone | 419-536-9294
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Fax | 419-536-9340
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3892
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003796
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License Number State | MI
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