Provider Demographics
NPI:1639114291
Name:SHAH EYE CENTER, P.A.
Entity Type:Organization
Organization Name:SHAH EYE CENTER, P.A.
Other - Org Name:SHAH EYE CENTER, P.A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PANKAJKUMAR
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-583-0202
Mailing Address - Street 1:1506 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2424
Mailing Address - Country:US
Mailing Address - Phone:956-583-0202
Mailing Address - Fax:956-583-0200
Practice Address - Street 1:1506 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2424
Practice Address - Country:US
Practice Address - Phone:956-583-0202
Practice Address - Fax:956-583-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080899003Medicaid
TX00626NMedicare UPIN
TX3922270001Medicare NSC