Provider Demographics
NPI:1114455144
Name:SACHDEVA, RAHI SHAH (OD)
Entity Type:Individual
Prefix:
First Name:RAHI
Middle Name:SHAH
Last Name:SACHDEVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:RAHI
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1825 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2762
Mailing Address - Country:US
Mailing Address - Phone:269-342-0003
Mailing Address - Fax:269-342-4284
Practice Address - Street 1:23055 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2071
Practice Address - Country:US
Practice Address - Phone:248-399-1556
Practice Address - Fax:248-399-2789
Is Sole Proprietor?:No
Enumeration Date:2017-06-04
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist