Provider Demographics
NPI:1184006439
Name:SHAH, RUCHI (OD)
Entity Type:Individual
Prefix:
First Name:RUCHI
Middle Name:
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 1:25 EAST WASHINGTON ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-5430
Mailing Address - Country:US
Mailing Address - Phone:312-444-1111
Mailing Address - Fax:312-444-1111
Practice Address - Street 1:25 EAST WASHINGTON ST
Practice Address - Street 2:SUITE 606
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-6060
Practice Address - Country:US
Practice Address - Phone:312-444-1111
Practice Address - Fax:312-444-1111
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011170152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist