Provider Demographics
NPI:1083862213
Name:SHINI OD PA
Entity Type:Organization
Organization Name:SHINI OD PA
Other - Org Name:EYETRENDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SIMAAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:979-694-2000
Mailing Address - Street 1:3525 LONGMIRE DR STE K
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5281
Mailing Address - Country:US
Mailing Address - Phone:979-694-2000
Mailing Address - Fax:979-694-2010
Practice Address - Street 1:3525 LONGMIRE DR STE K
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5281
Practice Address - Country:US
Practice Address - Phone:979-694-2000
Practice Address - Fax:979-694-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6652TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V04010Medicare UPIN
DS9647Medicare PIN
TX0A4748Medicare PIN