Individual
DR. JACOB D SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2251 N WOODLAWN ST, WICHITA, KS 67220-3947
(316) 686-6063
(316) 686-4214
Mailing address
2251 N WOODLAWN ST, WICHITA, KS 67220-3947
(316) 686-6063
(316) 686-4214
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1665
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200262380A
—
KS
01
—
267621
COVENTRY-LOC#2
KS
01
—
269147
COVENTRY-LOC#1
KS
05
—
463279
—
KS
01
—
8141
PPK
KS
Enumeration date
01/03/2006
Last updated
11/21/2007
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