Individual
MR. EDWARD F SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1295 PORTLAND AVE, SUITE 1, ROCHESTER, NY 14621-2731
(585) 544-3430
(585) 544-3473
Mailing address
1295 PORTLAND AVE, SUITE 1, ROCHESTER, NY 14621-2731
(585) 544-3430
(585) 544-3473
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
00002739
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00450564
—
NY
01
—
103245CT
PREFERRED CARE
NY
01
—
8720
BLUE CROSS BLUE SHIELD
NY
Enumeration date
03/11/2006
Last updated
07/09/2007
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