Provider Demographics
NPI:1851431878
Name:KIMBERLY SHIH O.D., INC
Entity Type:Organization
Organization Name:KIMBERLY SHIH O.D., INC
Other - Org Name:ROWLAND OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-581-4600
Mailing Address - Street 1:1727 FULLERTON RD
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:626-529-0927
Practice Address - Street 1:1727 FULLERTON RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2614
Practice Address - Country:US
Practice Address - Phone:626-581-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12857T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP12857COtherMEDICARE INDIVIDUAL PTAN
CAWOP12857COtherMEDICARE INDIVIDUAL PTAN