Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 734-081T | LA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 734-081T | LA |
NPI | 1265528665 |
---|---|
Provider Name | Lacy B Shaw |
First Address | Alexandria, LA 71303 |
Second Address | Alexandria, LA 71303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 05/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1153486 | (05) | LA |
16670 | STARMOUNT/ALWAYS VISION (01) | |
410008037 | RAILROAD MEDICARE (01) | |
48912 | (02) | LA |
720756964 | VISION SERVICE PLAN (01) | |
72-0756964 | AETNA (01) | |
72-0756964 | AMERICAN LIFE CARE (01) | |
72-0756964 | DEFINITY HEALTH (01) | |
72-0756964 | FARA (01) | |
72-0756964 | FIRST HEALTH (01) | |
72-0756964 | HUMANA (01) | |
72-0756964 | MAIL HANDLERS (01) | |
72-0756964 | OFFICE OF GROUP BENEFITS (01) | |
72-0756964 | PPO PLUS (01) | |
72-0756964 | UNITED HEALTHCARE (01) | |
85731 | SPECTERA (01) | |
LA4081 | EYEMED (01) |