Provider Demographics
NPI:1538139464
Name:SHOJI, NANCY ELAINE (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELAINE
Last Name:SHOJI
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 1:4213 DALE RD
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8505
Mailing Address - Country:US
Mailing Address - Phone:209-545-3937
Mailing Address - Fax:209-545-0204
Practice Address - Street 1:4213 DALE RD
Practice Address - Street 2:SUITE A-2
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8505
Practice Address - Country:US
Practice Address - Phone:209-545-3937
Practice Address - Fax:209-545-0204
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7879T152W00000X
CA07879T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0078790Medicaid
SD0078790Medicare UPIN
T10612Medicare ID - Type Unspecified