Shaw, Lacy B

Shaw, Lacy B is an sole proprietor health care provider with primary practice located at 5615-B Jackson St Ext , Alexandria LA 71303. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Shaw, Lacy B can be contacted via phone (318) 442-7787.

Contact Information

Primary practice address
5615-B Jackson St Ext Alexandria LA 71303
Phone: (318) 442-7787
Fax: (318) 443-1654
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 734-081T Louisiana
Eye and Vision Services Providers / Corneal and Contact Management 152WC0802X 734-081T Louisiana

Profile Details

NPI number 1265528665
LBN Legal business name Shaw, Lacy B
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 4th, 2006
Last updated Aug 5th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265528665 NPPES
Other 72-0756964 FARA
Other 72-0756964 FARA
Other 72-0756964 FARA
Other 72-0756964 FARA
Other LA4081 FARA
Other 72-0756964 FARA
Other 720756964 FARA
MEDICAID 1153486 FARA
Other 410008037 FARA
Other 72-0756964 FARA
Other 72-0756964 FARA
Other 72-0756964 FARA
Other 16670 FARA
Other 72-0756964 FARA
Other 72-0756964 FARA
Other 85731 FARA

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