MEDICARE: PUJA SHAH O.D, P.C

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	046010366	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538417498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUJA SHAH O.D, P.C

Provider Business Mailing Address
First Line	:	3220 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3797
Country	:	US
Telephone Number	:	773-661-6615
Fax Number	:	773-698-7408

Provider Business Practice Location Address
First Line	:	3220 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3797
Country	:	US
Telephone Number	:	773-661-6615
Fax Number	:	773-698-7408

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PUJA SHAH
Credential	:	O.D
Telephone Number	:	773-661-6615

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	08/28/2012

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