; NPI #1063555282

Contact Information

SHAWN M STALDER, OPTICIAN

1020 MAIN ST
HAMILTON, OH 45013

Phone: 513-896-7641
Fax: 513-896-7641
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Eyewear Supplier	332H00000X	87	All Other Suppliers
Optometrist	152W00000X	41	Optometry

Indicates primary specialty

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NPI Profile & details for

NPI # 1063555282

Entity Organization

Organization subpart ¹ Not specified

Enumeration date 02/15/2007

Last updated 05/12/2015 - About 11 years ago

Identifiers

OH	License #	52425
OH	Medicaid	2027265
OH	Other	925027	AMERIGROUP

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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