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Individual
DR. MARC D. SHAW
Active
Individual
DR. MARC D. SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6801T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
810673636
BLUE CROSS
CA
05
—
GR0005490
—
CA
Enumeration date
02/28/2007
Last updated
06/11/2008
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