Provider Demographics
NPI:1881850808
Name:SHIH, CHUN-CHIEH JACK (OD)
Entity Type:Individual
Prefix:DR
First Name:CHUN-CHIEH
Middle Name:JACK
Last Name:SHIH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16170 LEFFINGWELL RD STE 7
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-3170
Mailing Address - Country:US
Mailing Address - Phone:562-947-6789
Mailing Address - Fax:562-947-5688
Practice Address - Street 1:1679 S AZUSA AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-3832
Practice Address - Country:US
Practice Address - Phone:626-810-0858
Practice Address - Fax:626-810-1308
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADM216ZMedicare PIN