Provider Demographics
NPI:1467545590
Name:AGUILAR, SHANA NOBLE (OD)
Entity Type:Individual
Prefix:MS
First Name:SHANA
Middle Name:NOBLE
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:SHANA
Other - Middle Name:MARIE
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:5825 BONFAIR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1119
Mailing Address - Country:US
Mailing Address - Phone:562-822-9333
Mailing Address - Fax:
Practice Address - Street 1:5825 BONFAIR AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1119
Practice Address - Country:US
Practice Address - Phone:562-822-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12634T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist