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Individual
PETER G SHAW- MC MINN
Active
Individual
PETER G SHAW- MC MINN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT 6553T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06612
MEDICAL EYE SERVICES
CA
01
—
118498
EYEMED VISIONCARE
CA
01
—
12069
I.E.H.P.
CA
01
—
9516724971
VISION SERVICE PLAN
CA
01
—
FC49172
SAFEGUARD
CA
05
—
ZZZ81412Z
—
CA
Enumeration date
02/14/2006
Last updated
06/20/2012
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