Provider Demographics
NPI:1134455736
Name:DEBRA A. SHIM, O.D., P.A.
Entity type:Organization
Organization Name:DEBRA A. SHIM, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-625-4380
Mailing Address - Street 1:451 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3102
Mailing Address - Country:US
Mailing Address - Phone:561-625-4380
Mailing Address - Fax:561-625-3920
Practice Address - Street 1:451 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3102
Practice Address - Country:US
Practice Address - Phone:561-625-4380
Practice Address - Fax:561-625-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3312152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CL589AOtherMEDICARE PTAN
CL589AOtherMEDICARE PTAN
4435850001Medicare NSC