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NPI Code Detail

MEDICARE: JACK SHAO MD

MEDICARE: JACK SHAO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician35.126950OH

General Provider Information

NPI Number : 1710277454
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK SHAO MD
Provider Business Mailing Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-0001
Country : US
Telephone Number : 216-444-2020
Fax Number :
Provider Business Practice Location Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-2745
Country : US
Telephone Number : 216-444-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2011
Last Update Date : 05/10/2019

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