Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 125.070375 | IL |
NPI | 1003347584 |
---|---|
Provider Name | Lincoln Shaw |
First Address | Burr Ridge, IL 60527-6686 |
Second Address | Chicago, IL 60637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2017 |
Last Update Date | 01/07/2018 |