Provider Demographics
NPI:1689934127
Name:SHAKIR, OMAR RAZZAQUE (MD MBA)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:RAZZAQUE
Last Name:SHAKIR
Suffix:
Gender:M
Credentials:MD MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W PUTNAM AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6080
Mailing Address - Country:US
Mailing Address - Phone:203-900-7911
Mailing Address - Fax:203-900-7911
Practice Address - Street 1:600 W PUTNAM AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6080
Practice Address - Country:US
Practice Address - Phone:321-960-2664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291443207W00000X, 207WX0107X
CT55031207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008082958Medicaid