MEDICARE: DR. KRUTI NAVIN SHAH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2841	CT
2	152W00000X	Optometrist	27OA00637900	NJ

General Provider Information

NPI Number	:	1154698868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRUTI NAVIN SHAH O.D.

Provider Business Mailing Address
First Line	:	88 N HILLSIDE AVE
Second Line	:
City	:	KENVIL
State	:	NJ
Zip	:	07847-2584
Country	:	US
Telephone Number	:	203-558-8016
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 SPARTA AVE
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-1120
Country	:	US
Telephone Number	:	203-558-8016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	01/07/2013

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