Healthcare Provider Details

I. General information

NPI: 1467147793
Provider Name (Legal Business Name): AMI SHAH VIRA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 LAVON BND
AUSTIN TX
78717-4169
US

IV. Provider business mailing address

10012 LAVON BND
AUSTIN TX
78717-4169
US

V. Phone/Fax

Practice location:
  • Phone: 512-553-9545
  • Fax: 484-968-8082
Mailing address:
  • Phone: 512-553-9545
  • Fax: 484-968-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: CIARA LEWIS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 606-767-5023