Provider Demographics
NPI:1962452409
Name:SHAH, AMIT (OD)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24441 KATY FWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1376
Mailing Address - Country:US
Mailing Address - Phone:281-392-4010
Mailing Address - Fax:281-715-5888
Practice Address - Street 1:24441 KATY FWY
Practice Address - Street 2:SUITE 300
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1376
Practice Address - Country:US
Practice Address - Phone:281-392-4010
Practice Address - Fax:281-715-5888
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06256TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347918ZCLWOtherMEDICARE PTAN