Provider Demographics
NPI:1902903503
Name:TAPAN R SHAH, MD, LTD
Entity Type:Organization
Organization Name:TAPAN R SHAH, MD, LTD
Other - Org Name:AVISTA EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAPAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-258-2020
Mailing Address - Street 1:3100 W CHARLESTON BLVD
Mailing Address - Street 2:#200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1900
Mailing Address - Country:US
Mailing Address - Phone:702-258-2020
Mailing Address - Fax:702-258-3681
Practice Address - Street 1:3100 W CHARLESTON BLVD
Practice Address - Street 2:#200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1900
Practice Address - Country:US
Practice Address - Phone:702-258-2020
Practice Address - Fax:702-258-3681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty