Organization
SHADER VISION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN D SHADER DO (MEDICAL DIRECTOR)
(541) 990-0354
Entity
Organization
Contact information
Practice address
297 LAKE HAVASU AVE S STE 204, LAKE HAVASU CITY, AZ 86403-6526
(541) 990-0354
Mailing address
43241 PIETRA CT, INDIO, CA 92203-2928
(541) 990-0354
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
08/08/2024
Last updated
08/08/2024
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