Provider Demographics
NPI:1639256274
Name:SHAH, VIRAJ J (OD)
Entity Type:Individual
Prefix:DR
First Name:VIRAJ
Middle Name:J
Last Name:SHAH
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:4810 ELK GROVE BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4186
Mailing Address - Country:US
Mailing Address - Phone:916-478-2778
Mailing Address - Fax:916-478-2779
Practice Address - Street 1:4810 ELK GROVE BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-4186
Practice Address - Country:US
Practice Address - Phone:916-478-2778
Practice Address - Fax:916-478-2779
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAOPT12464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0124640Medicaid