Provider Demographics
NPI:1215932652
Name:SHAHEEN, KALEEL JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:KALEEL
Middle Name:JAMES
Last Name:SHAHEEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 HILLS AND DALES RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1507
Mailing Address - Country:US
Mailing Address - Phone:330-478-8996
Mailing Address - Fax:330-478-9987
Practice Address - Street 1:4555 HILLS AND DALES RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1507
Practice Address - Country:US
Practice Address - Phone:330-478-8996
Practice Address - Fax:330-478-9987
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-04-04
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
OH3044T647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0197675Medicaid
OH0197675Medicaid
OHSH0380113Medicare ID - Type Unspecified