Provider Demographics
NPI:1114630050
Name:SHAH, HAMZA (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:HAMZA
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 FOREST AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2414
Mailing Address - Country:US
Mailing Address - Phone:312-278-5254
Mailing Address - Fax:
Practice Address - Street 1:5301 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2113
Practice Address - Country:US
Practice Address - Phone:773-944-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist