Provider Demographics
NPI:1851537906
Name:SHAH EYE CENTER, P.A.
Entity Type:Organization
Organization Name:SHAH EYE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PANKAJKUMAR
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-583-0202
Mailing Address - Street 1:2025 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3222
Mailing Address - Country:US
Mailing Address - Phone:956-583-0202
Mailing Address - Fax:956-583-0200
Practice Address - Street 1:8607 MCPHERSON RD
Practice Address - Street 2:STE 102
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6382
Practice Address - Country:US
Practice Address - Phone:956-753-0202
Practice Address - Fax:956-753-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9336332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080899003Medicaid
TX080899003Medicaid
TX00626NMedicare UPIN