Provider Demographics
NPI:1386620334
Name:SHAPIRO, ARNOLD (OD)
Entity type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N VIENNA AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08215-3246
Mailing Address - Country:US
Mailing Address - Phone:843-860-2644
Mailing Address - Fax:
Practice Address - Street 1:WALMART VISION CENTER, 631 RT. 9 S.
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08087
Practice Address - Country:US
Practice Address - Phone:609-296-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00443331OtherRR MEDICARE
SC65-1178684OtherTAX ID
SCD12350Medicaid
SCD12350Medicaid
SC65-1178684OtherTAX ID