Provider Demographics
NPI:1083638944
Name:SHAH, ARTI SURENDRA (OD)
Entity type:Individual
Prefix:
First Name:ARTI
Middle Name:SURENDRA
Last Name:SHAH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12727 NOTTINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7275
Mailing Address - Country:US
Mailing Address - Phone:310-966-7465
Mailing Address - Fax:
Practice Address - Street 1:12727 NOTTINGHAM ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7275
Practice Address - Country:US
Practice Address - Phone:310-966-7465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAT11392152WC0802X
NY006279152W00000X, 152WC0802X
CAOPT11392152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0113920OtherMEDICAL PPIN #
CASD0113920OtherMEDICAL PPIN #
CAWOP11392AMedicare ID - Type UnspecifiedPPIN #