Shader Vision

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

SHADER VISION

Practice address

297 Lake Havasu Ave S Ste 204
Lake Havasu City, AZ 86403-6526

Phone

(541) 990-0354

NPI assigned

Aug 8, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jonathan D Shader, DONPI 1689038986

Title

Medical Director

Phone

(541) 990-0354

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: jshader@shader.intellechartdirect.net

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jonathan Shader, DO

  • Ophthalmology Physician
  • Lake Havasu City, AZ
  • NPI 1689038986
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723075200000",
    "number": "1043041486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43241 PIETRA CT",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922032928",
            "telephone_number": "541-990-0354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "297 LAKE HAVASU AVE S STE 204",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036526",
            "telephone_number": "541-990-0354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADER VISION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-08",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A",
        "authorized_official_last_name": "SHADER",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "541-990-0354",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sego Medical Associates LLC
• Lynda Selk, APRN
• Bryant M Senica, OD
• Serenity Assisted Living
• Prerana Sevak
• Jonathan Shader, DO
• Nicole Genevieve Shadwick, CRNA
• Khizer Salim Shaikh, M.D.
• Shalom Enterprise
• Jahan Shiravand

• Ophthalmology Physician in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Ophthalmology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.