Provider Demographics
NPI:1134873136
Name:AV EYECARE
Entity type:Organization
Organization Name:AV EYECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:VIDHI
Authorized Official - Middle Name:ATUL
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-258-2020
Mailing Address - Street 1:1470 N KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4702
Mailing Address - Country:US
Mailing Address - Phone:510-456-8115
Mailing Address - Fax:
Practice Address - Street 1:4070 N BELT LINE RD STE 168
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-5010
Practice Address - Country:US
Practice Address - Phone:972-258-2020
Practice Address - Fax:972-250-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty