NPIMap

Organization Active NPI

Jack Shaw Superior Eye Care

  • Optician
  • Chicago, IL
National Provider Identifier
1104040328
Registry record updated Aug 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
JACK SHAW SUPERIOR EYE CARE
Practice address
2906 N Broadway St
Chicago, IL 60657-7163
Phone
(773) 525-1601
Fax
(773) 435-4210
NPI assigned
Apr 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2015

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

Authorized official

Name
Mr. Jack Shaw, OPTICIANNPI 1104947316
Title
Owner
Phone
(773) 525-1601

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1800X Primary

Addresses

Primary practice location

2906 N Broadway St
Chicago, IL 60657-7163

Mailing address

2906 N Broadway St
Chicago, IL 60657-7163
Phone (773) 525-1601

Other names 1

  • superior eye care Doing business as

National Provider Directory

National Provider Directory

Locations

2906 N Broadway St
Chicago, IL 60657
Phone (773) 525-1601

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439942400000",
    "number": "1104040328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2906 N BROADWAY ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606577163",
            "telephone_number": "773-525-1601",
            "fax_number": "773-435-4210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2906 N BROADWAY ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606577163",
            "telephone_number": "773-525-1601",
            "fax_number": "773-435-4210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK SHAW SUPERIOR EYE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2015-08-19",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-525-1601",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "superior eye care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.