Healthcare Provider Details

I. General information

NPI: 1851569883
Provider Name (Legal Business Name): RAJNI SHAH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAJNI SINGH

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BUSHAWAY RD STE 300
WAYZATA MN
55391-1945
US

IV. Provider business mailing address

3333 HAZELTON RD
EDINA MN
55435-4204
US

V. Phone/Fax

Practice location:
  • Phone: 952-475-3787
  • Fax:
Mailing address:
  • Phone: 612-360-5572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3113
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: