Provider Demographics
NPI:1881665388
Name:SHAH, AMI PATEL (OD)
Entity Type:Individual
Prefix:DR
First Name:AMI
Middle Name:PATEL
Last Name:SHAH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMI
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4810 ELK GROVE BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4186
Mailing Address - Country:US
Mailing Address - Phone:562-841-0757
Mailing Address - Fax:916-478-2779
Practice Address - Street 1:4810 ELK GROVE BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-4186
Practice Address - Country:US
Practice Address - Phone:562-841-0757
Practice Address - Fax:916-478-2779
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12341152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6137200001Medicare NSC
CAU97302Medicare UPIN
CABH210Medicare PIN