Provider Demographics
NPI:1801023049
Name:SHAH VIRA, AMI AMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMI
Middle Name:AMAR
Last Name:SHAH VIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMI
Other - Middle Name:AJIT
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10012 LAVON BND
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4169
Mailing Address - Country:US
Mailing Address - Phone:512-553-9545
Mailing Address - Fax:484-968-8082
Practice Address - Street 1:210 N LAKELINE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2088
Practice Address - Country:US
Practice Address - Phone:512-553-9545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3461207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83050379OtherTAX ID
OHP01224890OtherRAILROAD MEDICARE
OH0086493Medicaid