Provider Demographics
NPI:1689819039
Name:SAMIR B. SHAH, MD, INC.
Entity type:Organization
Organization Name:SAMIR B. SHAH, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:BIPIN
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-296-6100
Mailing Address - Street 1:301 LENNON LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2483
Mailing Address - Country:US
Mailing Address - Phone:925-296-6100
Mailing Address - Fax:925-932-8650
Practice Address - Street 1:301 LENNON LN
Practice Address - Street 2:SUITE 201
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2483
Practice Address - Country:US
Practice Address - Phone:925-296-6100
Practice Address - Fax:925-932-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68255207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty