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General NPI Number Information
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NPI Number | 1356588404
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Entity Type | Individual
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Provider Name | JASON SHEN OPT
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Gender | Male
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 458 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10016-6027
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Country | US
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Telephone | 212-696-5990
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Fax | 212-696-5990
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Provider Business Mailing Address
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Address Line | 47 MOTT ST APT 45
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City | NEW YORK
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State | NY
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Zip | 10013-5014
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Country | US
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Telephone |
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Fax |
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 0085391
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License Number State | NY
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