Provider Demographics
NPI:1992237812
Name:SHAHI, MANPREET KAUR (OD)
Entity type:Individual
Prefix:DR
First Name:MANPREET
Middle Name:KAUR
Last Name:SHAHI
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 1:4209 MAGGIE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-1687
Mailing Address - Country:US
Mailing Address - Phone:219-315-9753
Mailing Address - Fax:
Practice Address - Street 1:1908 SOUTHLAKE MALL
Practice Address - Street 2:AL 104
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6435
Practice Address - Country:US
Practice Address - Phone:219-791-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004014A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist