MEDICARE: ADITYA MEHTA M.D.

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	MD2021-0820	NM
2	207W00000X	Ophthalmology Physician	MD61619491	WA
3	207W00000X	Ophthalmology Physician	CDR.0006983	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD2021-0820	OTHER	NM	NM LICENSE
2	MD61619491	OTHER	WA	WA LICENSE
3	CDR.0006983	OTHER	CO	CO LICENSE
4	S3023	OTHER	TX	TX LICENSE

General Provider Information

NPI Number	:	1679964324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADITYA MEHTA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1668
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-5001
Country	:	US
Telephone Number	:	360-426-2653
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 N 13TH ST
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-2077
Country	:	US
Telephone Number	:	360-426-2653
Fax Number	:

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

Provider Enumeration Date	:	02/16/2015
Last Update Date	:	05/20/2026

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