MEDICARE: SHIMUL Y SHAH

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	261QH0100X	Health Service Clinic/Center	5091	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1043254170	OTHER	OH	INDIVIDUAL NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316122724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIMUL Y SHAH

Provider Business Mailing Address
First Line	:	122 N MAIN ST
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-1106
Country	:	US
Telephone Number	:	937-642-1300
Fax Number	:	937-642-0101

Provider Business Practice Location Address
First Line	:	122 N MAIN ST
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-1106
Country	:	US
Telephone Number	:	937-642-1300
Fax Number	:	937-642-0101

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. SHIMUL Y SHAH
Credential	:	O.D.
Telephone Number	:	937-642-1300

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	06/04/2013

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Directions to “SHIMUL Y SHAH ” Practice Location

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