Provider Demographics
NPI:1598070955
Name:SHIM, SARAH E (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:E
Last Name:SHIM
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 1:415 W CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-4267
Mailing Address - Country:US
Mailing Address - Phone:706-278-6113
Mailing Address - Fax:
Practice Address - Street 1:415 W CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-4267
Practice Address - Country:US
Practice Address - Phone:706-278-6113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN3019152W00000X
GA002637152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10341I481Medicare PIN