MEDICARE: MR. EDWARD F SHAW

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
1	156FX1800X	Optician	00002739	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8720	OTHER	NY	BLUE CROSS BLUE SHIELD
3	103245CT	OTHER	NY	PREFERRED CARE

General Provider Information

NPI Number	:	1821066135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD F SHAW

Provider Business Mailing Address
First Line	:	1295 PORTLAND AVE
Second Line	:	SUITE 1
City	:	ROCHESTER
State	:	NY
Zip	:	14621-2731
Country	:	US
Telephone Number	:	585-544-3430
Fax Number	:	585-544-3473

Provider Business Practice Location Address
First Line	:	1295 PORTLAND AVE
Second Line	:	SUITE 1
City	:	ROCHESTER
State	:	NY
Zip	:	14621-2731
Country	:	US
Telephone Number	:	585-544-3430
Fax Number	:	585-544-3473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2006
Last Update Date	:	07/09/2007

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Directions to “ MR. EDWARD F SHAW ” Practice Location

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