Provider Demographics
NPI:1386667806
Name:SHAH, DINA RASIK (OD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:RASIK
Last Name:SHAH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:827 DEEP VALLEY DR
Mailing Address - Street 2:STE 311
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3647
Mailing Address - Country:US
Mailing Address - Phone:310-541-3411
Mailing Address - Fax:310-541-6678
Practice Address - Street 1:827 DEEP VALLEY DR
Practice Address - Street 2:STE 311
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3647
Practice Address - Country:US
Practice Address - Phone:310-541-3411
Practice Address - Fax:310-541-6678
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12892152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WOP12892BMedicare ID - Type Unspecified
CAV12101Medicare UPIN