Provider Demographics
NPI:1093377723
Name:SARAH A SHAW OD OPTOMETRIST PLLC
Entity type:Organization
Organization Name:SARAH A SHAW OD OPTOMETRIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-417-2996
Mailing Address - Street 1:215 EAST AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094
Mailing Address - Country:US
Mailing Address - Phone:716-434-2874
Mailing Address - Fax:716-434-7809
Practice Address - Street 1:215 EAST AVENUE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094
Practice Address - Country:US
Practice Address - Phone:716-434-2874
Practice Address - Fax:716-434-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty