IndividualActive
Jack Shaw, OPTICIAN
NPI 1104947316 · Technician/Technologist · Chicago, IL
Provider details
- NPI number
- 1104947316
- Entity type
- Individual
- Primary specialty
- Technician/TechnologistEye and Vision Services Providers
- Credential
- OPTICIAN
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Eye and Vision Services Providers
Practice location
2906 N Broadway St
Chicago, IL 60657-7163
Phone: (773) 525-1601
Fax: (773) 435-4210
Approximate (ZIP-level) locationGet directions
Mailing address
2906 N Broadway St
Chicago, IL 60657-7163
Registry dates
- Enumerated
- 2007-04-03
- Last updated
- 2015-05-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.