1750366357 NPI number — DR. HERBERT MORTON SHUER O.D.

Table of content: DR. HERBERT MORTON SHUER O.D. (NPI 1750366357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750366357 NPI number — DR. HERBERT MORTON SHUER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUER
Provider First Name:
HERBERT
Provider Middle Name:
MORTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
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:
1750366357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 RICHARD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02492-4321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-449-5060
Provider Business Mailing Address Fax Number:
781-449-5060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02461-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-332-2023
Provider Business Practice Location Address Fax Number:
617-332-1218
Provider Enumeration Date:
12/07/2005

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:  MA2425TPA , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04-3049120 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22-00032 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04-3049120 . This is a "COMMONWEALTH INDEMNITY PL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 8369961 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AETNA . This is a "0093633" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W15801 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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