Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 006279 | NY |
N | 152W00000X | Optometrist | OPT11392 | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 006279 | NY |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | T11392 | CA |
NPI | 1083638944 |
---|---|
Provider Name | Arti Surendra Shah |
First Address | Cerritos, CA 90703-7275 |
Second Address | Cerritos, CA 90703-7275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0113920 | MEDICAL PPIN # (01) | CA |
U86073 | (02) | CA |