Healthcare Provider Details

I. General information

NPI: 1558747428
Provider Name (Legal Business Name): SHABANA NAWAZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CROSSINGS BLVD
ELVERSON PA
19520-9069
US

IV. Provider business mailing address

1050 SNYDER AVE
PHOENIXVILLE PA
19460-1895
US

V. Phone/Fax

Practice location:
  • Phone: 610-938-3630
  • Fax:
Mailing address:
  • Phone: 312-731-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003629
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: