Provider Demographics
NPI:1396178505
Name:SHAH, SEEMA MAHESH (OD)
Entity Type:Individual
Prefix:
First Name:SEEMA
Middle Name:MAHESH
Last Name:SHAH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SEEMA
Other - Middle Name:MAHESH
Other - Last Name:SHROFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:195 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006
Mailing Address - Country:US
Mailing Address - Phone:973-228-4990
Mailing Address - Fax:732-698-9462
Practice Address - Street 1:195 FAIRFIELD AVE
Practice Address - Street 2:SUITE 4B
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006
Practice Address - Country:US
Practice Address - Phone:973-228-4990
Practice Address - Fax:732-698-9462
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00649900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist