1407824261 NPI number — DR. DAVID L SHAFF OD

Table of content: DR. DAVID L SHAFF OD (NPI 1407824261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407824261 NPI number — DR. DAVID L SHAFF OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAFF
Provider First Name:
DAVID
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407824261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
533 W COMMERCIAL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14445-2276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-586-6882
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
533 W COMMERCIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14445-2276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-586-6882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TUV003038 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 161168030 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00091163900 . This is a "HEALTH NOW" identifier . This identifiers is of the category "OTHER".
  • Identifier: 161168030 . This is a "EMPIRE UHC EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101433CS . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161168030 . This is a "SIDNEY HILLMAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 161168030 . This is a "WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010003038 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161168030 . This is a "DOCTORS HEALTH PLAN POMCO" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010003038 . This is a "MONROE PLAN BL CH OPT CHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 161168030 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010003038 . This is a "BCBS EXCELLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 161168030 . This is a "GHI GROUP HEALTH INCORPOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7700447 . This is a "MVP SELECT CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410043022 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101933CS . This is a "PREFERRED CARE OPTION" identifier . This identifiers is of the category "OTHER".




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