Healthcare Provider Details

I. General information

NPI: 1104610518
Provider Name (Legal Business Name): ROSHNI SHAH PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18574 PROSPECT RD
SARATOGA CA
95070-3646
US

IV. Provider business mailing address

2191 WELLINGTON DR
MILPITAS CA
95035-7513
US

V. Phone/Fax

Practice location:
  • Phone: 925-917-9762
  • Fax:
Mailing address:
  • Phone: 925-917-9762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: ROSHNI SHAH
Title or Position: OPTOMETRIST/PRESIDENT
Credential: OD
Phone: 925-917-9762