Provider Demographics
NPI:1063465821
Name:SHAH, SONAL H (OD)
Entity Type:Individual
Prefix:DR
First Name:SONAL
Middle Name:H
Last Name:SHAH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3324
Mailing Address - Country:US
Mailing Address - Phone:732-505-0533
Mailing Address - Fax:732-505-6572
Practice Address - Street 1:670 ROUTE 1 NORTH
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830
Practice Address - Country:US
Practice Address - Phone:732-636-1400
Practice Address - Fax:732-636-1401
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ036477Medicare ID - Type Unspecified
NJU79547Medicare UPIN