MEDICARE: SHEHZAD Y BATLIWALA D.O

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	207W00000X	Ophthalmology Physician	6361	OK
2	207W00000X	Ophthalmology Physician	T5827	TX

General Provider Information

NPI Number	:	1174054860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEHZAD Y BATLIWALA D.O

Provider Business Mailing Address
First Line	:	22715 E 102ND PL S
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-2473
Country	:	US
Telephone Number	:	903-262-7212
Fax Number	:

Provider Business Practice Location Address
First Line	:	10010 E 81ST ST STE 100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-4558
Country	:	US
Telephone Number	:	918-250-2020
Fax Number	:

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

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	10/06/2022

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