Provider Demographics
NPI:1851536098
Name:SHAMA, AMIR M (OD)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:M
Last Name:SHAMA
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 1:2550 S 25TH E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6507
Mailing Address - Country:US
Mailing Address - Phone:208-552-7323
Mailing Address - Fax:208-552-7325
Practice Address - Street 1:2550 S 25TH E
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6507
Practice Address - Country:US
Practice Address - Phone:208-552-7323
Practice Address - Fax:208-552-7325
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13617152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist