Provider Demographics
NPI:1669809844
Name:JONATHAN F. SHAVER, O.D.
Entity type:Organization
Organization Name:JONATHAN F. SHAVER, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-871-0921
Mailing Address - Street 1:718 N 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7621
Mailing Address - Country:US
Mailing Address - Phone:479-871-0921
Mailing Address - Fax:
Practice Address - Street 1:110 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE GROVE
Practice Address - State:AR
Practice Address - Zip Code:72753-2655
Practice Address - Country:US
Practice Address - Phone:479-871-0921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2549152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty