Provider Demographics
NPI:1679742241
Name:SHIN, ANNE N (OD)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:N
Last Name:SHIN
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 1:27011 MCBEAN PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5148
Mailing Address - Country:US
Mailing Address - Phone:661-253-3888
Mailing Address - Fax:
Practice Address - Street 1:27011 MCBEAN PKWY STE 107
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5148
Practice Address - Country:US
Practice Address - Phone:661-253-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12595152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist