Provider Demographics
NPI:1487657672
Name:SHIN, Y. VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:Y.
Middle Name:VICTOR
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 MAYFIELD RD
Mailing Address - Street 2:STE 338
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2299
Mailing Address - Country:US
Mailing Address - Phone:440-442-4330
Mailing Address - Fax:440-442-4695
Practice Address - Street 1:6770 MAYFIELD RD
Practice Address - Street 2:STE 338
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:440-442-4330
Practice Address - Fax:440-442-4695
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-6082-S207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000130733OtherANTHEM BC/BS
OH0801004OtherUNITED HEALTHCARE
OH180016877OtherRAILROAD MEDICARE
OH341345260027OtherCARESOURCE
OH922348OtherEYEMED
OH0528307Medicaid
OH34134526000OtherBUREAU OF WORKERS COMP
OH112070001OtherADMINISTAR FEDERAL
OH102468OtherKAISER
OH341345260OtherAETNA
OH34134526000OtherBUREAU OF WORKERS COMP