Individual
SHIMUL Y SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
122 N MAIN ST, MARYSVILLE, OH 43040-1106
(937) 642-1300
(937) 642-0101
Mailing address
122 N MAIN ST, MARYSVILLE, OH 43040-1106
(937) 642-1300
(937) 642-0101
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OH5091
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043254170
MEDICARE INDIVIDUAL PTAN H213271
OH
01
—
1316122724
MEDICARE GROUP PTAN H213270
OH
05
—
2636099
—
OH
Enumeration date
06/16/2006
Last updated
08/06/2014
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