Provider Demographics
NPI:1578782082
Name:PISHEH, SHAHLA (OD)
Entity Type:Individual
Prefix:DR
First Name:SHAHLA
Middle Name:
Last Name:PISHEH
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 1:700 SILKEN XING
Mailing Address - Street 2:SUITE 2002
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5595
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 SILKEN XING
Practice Address - Street 2:SUITE 2002
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5595
Practice Address - Country:US
Practice Address - Phone:972-723-2727
Practice Address - Fax:972-775-6539
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist