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General NPI Number Information
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NPI Number | 1134481211
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Entity Type | Individual
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Provider Name | BIRVA K SHAH O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 10436 SOUTHWEST HWY SUITE 101
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-2282
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Country | US
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Telephone | 708-423-4192
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Fax | 708-952-0329
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Provider Business Mailing Address
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Address Line | 4684 DEPT
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City | CAROL STREAM
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State | IL
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Zip | 60122-4684
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Country | US
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Telephone | 708-423-4192
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Fax | 708-952-0329
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046010543
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 046010543
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License Number State | IL
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