Provider Demographics
NPI:1013951409
Name:SHAH, VINAY ASHOK (MD)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:ASHOK
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3366 NW EXPRESSWAY STE 670
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4416
Mailing Address - Country:US
Mailing Address - Phone:405-691-0505
Mailing Address - Fax:405-691-0507
Practice Address - Street 1:9821 S MAY AVE STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7042
Practice Address - Country:US
Practice Address - Phone:405-691-0505
Practice Address - Fax:405-691-0507
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28311207W00000X, 207WX0107X
MI4301093697207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200344830AMedicaid
OKOKAAA1546Medicare PIN