Lacy B Shaw, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

734-081T Issued in LA

Practice address

5615-B Jackson St Ext
Alexandria, LA 71303

Phone

(318) 442-7787

Fax

(318) 443-1654

NPI assigned

Oct 4, 2006

Last updated

Aug 5, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 16

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vision Source Alexandria LLC

  • Optometrist
  • Alexandria, LA
  • NPI 1356694434
  Medicare reassignment NPD Authorized official
• Cenla Vision Source, LLC

  dba Cenla Vision Source

  • Optometrist
  • Alexandria, LA
  • NPI 1295558351
  NPD

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407196800000",
    "number": "1265528665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5615-B JACKSON ST EXT",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "71303",
            "telephone_number": "318-442-7787",
            "fax_number": "318-443-1654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5615-B JACKSON ST EXT",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "71303",
            "telephone_number": "318-442-7787",
            "fax_number": "318-443-1654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "LACY",
        "middle_name": "B",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2014-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "734-081T",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "LA",
            "license": "734-081T",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1153486",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STARMOUNT/ALWAYS VISION",
            "identifier": "16670",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OFFICE OF GROUP BENEFITS",
            "identifier": "72-0756964",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410008037",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FARA",
            "identifier": "72-0756964",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "72-0756964",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "LA4081",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN LIFE CARE",
            "identifier": "72-0756964",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "72-0756964",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPO PLUS",
            "identifier": "72-0756964",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "72-0756964",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEFINITY HEALTH",
            "identifier": "72-0756964",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "72-0756964",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAIL HANDLERS",
            "identifier": "72-0756964",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "85731",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISION SERVICE PLAN",
            "identifier": "720756964",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Share Care USA
• Mohammed Tanzeel Sharief, MD, MBA, MS
• Deepak Sharma, M.D.
• Jerri Jenelle Sharp, HIS
• Wilbur Eric Sharp, NNP-BC
• Mohammad Shbeeb, M.D.
• Elham Shehadah
• Connie Shell
• Shelley Gildwarg, LCSW LLC
• Michelle Malzahn Shelton, PA-C

• Optometrist in Alexandria, LA
• Providers in Alexandria, LA by specialty
• Optometrist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.