Provider Demographics
NPI:1154435980
Name:SHAPIRO, ROBERT ALLAN (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLAN
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7906 MARSHALL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-2253
Mailing Address - Country:US
Mailing Address - Phone:757-826-0197
Mailing Address - Fax:757-838-0809
Practice Address - Street 1:7906 MARSHALL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-2253
Practice Address - Country:US
Practice Address - Phone:757-826-0197
Practice Address - Fax:757-838-0809
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000517152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009203630Medicaid
VA580936077Medicare PIN
VAT21827Medicare UPIN
VA009203630Medicaid