Provider Demographics
NPI:1679201032
Name:SHAH, ARSH (OD)
Entity Type:Individual
Prefix:DR
First Name:ARSH
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 PAWTUCKET BLVD UNIT 12
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-1073
Mailing Address - Country:US
Mailing Address - Phone:978-761-3488
Mailing Address - Fax:
Practice Address - Street 1:1431 PAWTUCKET BLVD UNIT 12
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-1073
Practice Address - Country:US
Practice Address - Phone:978-761-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty