MEDICARE: DR. HAMZA SHAH OD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046011711	IL

General Provider Information

NPI Number	:	1114630050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAMZA SHAH OD, MS

Provider Business Mailing Address
First Line	:	814 FOREST AVE APT 2E
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-2414
Country	:	US
Telephone Number	:	312-278-5254
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2113
Country	:	US
Telephone Number	:	773-944-1039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2023
Last Update Date	:	01/05/2023

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