Individual
MR. SHAWN M STALDER
Active
Individual
MR. SHAWN M STALDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
52425
OH
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2027265
—
OH
01
—
925027
AMERIGROUP
OH
Enumeration date
02/15/2007
Last updated
05/12/2015
Update your record
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