Provider Demographics
NPI:1376821017
Name:SHAH, AASHAY (OD)
Entity Type:Individual
Prefix:
First Name:AASHAY
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612-D SOUTHFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129
Mailing Address - Country:US
Mailing Address - Phone:618-334-5871
Mailing Address - Fax:
Practice Address - Street 1:106 E BARNETT AVE
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535
Practice Address - Country:US
Practice Address - Phone:217-877-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist