Healthcare Provider Details

I. General information

NPI: 1306772942
Provider Name (Legal Business Name): VIRAL M SHAH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 HADDONTOWNE CT
CHERRY HILL NJ
08034-3602
US

IV. Provider business mailing address

122 HADDONTOWNE CT
CHERRY HILL NJ
08034-3602
US

V. Phone/Fax

Practice location:
  • Phone: 856-375-2454
  • Fax:
Mailing address:
  • Phone: 856-375-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00742800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: