Individual
LACY B SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5615-B JACKSON ST EXT, ALEXANDRIA, LA 71303
(318) 442-7787
(318) 443-1654
Mailing address
5615-B JACKSON ST EXT, ALEXANDRIA, LA 71303
(318) 442-7787
(318) 443-1654
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
734-081T
LA
152WC0802X
Corneal and Contact Management Optometrist
734-081T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1153486
—
LA
01
—
16670
STARMOUNT/ALWAYS VISION
—
01
—
410008037
RAILROAD MEDICARE
—
01
—
72-0756964
FARA
—
01
—
720756964
VISION SERVICE PLAN
—
01
—
85731
SPECTERA
—
01
—
LA4081
EYEMED
—
Enumeration date
10/04/2006
Last updated
08/05/2014
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