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General NPI Number Information
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NPI Number | 1356793285
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Entity Type | Individual
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Provider Name | KARAN SHAH O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2016
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Last Update Date | 07/03/2016
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Provider Practice Location Address
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Address Line | 3393 PEACHTREE RD NE
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City | ATLANTA
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State | GA
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Zip | 30326-1162
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Country | US
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Telephone | 404-233-9296
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Fax |
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Provider Business Mailing Address
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Address Line | 2349 JOMARC WAY
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City | MARIETTA
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State | GA
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Zip | 30062-2611
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Country | US
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Telephone | 770-971-7460
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Fax |
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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 | OPT002955
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License Number State | GA
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