Provider Demographics
NPI:1083878128
Name:SHANMUGAM, KOMAL V (OD)
Entity Type:Individual
Prefix:DR
First Name:KOMAL
Middle Name:V
Last Name:SHANMUGAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KOMAL
Other - Middle Name:B
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1321 N LOOP 1604 E
Mailing Address - Street 2:SUITE 100-A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1437
Mailing Address - Country:US
Mailing Address - Phone:210-782-8205
Mailing Address - Fax:210-545-2147
Practice Address - Street 1:1321 N LOOP 1604 E
Practice Address - Street 2:SUITE 100-A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1437
Practice Address - Country:US
Practice Address - Phone:210-782-8205
Practice Address - Fax:210-545-2147
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7674TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist