Provider Demographics
NPI:1093181158
Name:SHIN, PEARL (OD)
Entity Type:Individual
Prefix:DR
First Name:PEARL
Middle Name:
Last Name:SHIN
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 1:10826 OLD MILL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2660
Mailing Address - Country:US
Mailing Address - Phone:402-898-3232
Mailing Address - Fax:
Practice Address - Street 1:10826 OLD MILL RD STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2660
Practice Address - Country:US
Practice Address - Phone:402-898-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4285152W00000X
NE1554152W00000X
TN3698152W00000X
KS2167152W00000X
WAOD61030676152W00000X
ALR-310152W00000X
COOPT.0003163152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist