Provider Demographics
NPI:1326046251
Name:SHIN, CARL K (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:K
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2141 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1323
Mailing Address - Country:US
Mailing Address - Phone:440-354-6900
Mailing Address - Fax:440-354-6400
Practice Address - Street 1:2141 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1323
Practice Address - Country:US
Practice Address - Phone:440-354-6900
Practice Address - Fax:440-354-6400
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35043576207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0483230Medicaid
OH0483230Medicaid
OH0509962Medicare PIN
OH180001250Medicare PIN