Provider Demographics
NPI:1417172933
Name:HARSHAD G SHAH MD PA EYE INSTITUTE
Entity Type:Organization
Organization Name:HARSHAD G SHAH MD PA EYE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARSHAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:432-686-2020
Mailing Address - Street 1:4214 ANDREWS HWY STE 105
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4813
Mailing Address - Country:US
Mailing Address - Phone:432-686-2020
Mailing Address - Fax:432-570-0888
Practice Address - Street 1:4214 ANDREWS HWY STE 105
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4813
Practice Address - Country:US
Practice Address - Phone:432-686-2020
Practice Address - Fax:432-570-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7461174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083174501Medicaid
TXDB8827OtherRAILROAD MEDICARE
NMV3363OtherNEW MEXICO PROVIDER NUMBE
TXDB8827OtherRAILROAD MEDICARE
NMV3363OtherNEW MEXICO PROVIDER NUMBE