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Individual
DR. MIRAGE SHAH
Active
Individual
DR. MIRAGE SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
8314-TG
TX
152W00000X
Optometrist
OEG002675
PA
152W00000X
Optometrist
Primary
TA2615
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8314
TEXAS OPTOMETRY BOARD
TX
01
—
OEG002675
OPTOMETRY LICENSE NUMBER
PA
Enumeration date
07/19/2012
Last updated
05/13/2019
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