Provider Demographics
NPI:1376610592
Name:SHINMORI, TINA (OD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:SHINMORI
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 1:17535 PINE CONE CT
Mailing Address - Street 2:
Mailing Address - City:MONTE SERENO
Mailing Address - State:CA
Mailing Address - Zip Code:95030-2235
Mailing Address - Country:US
Mailing Address - Phone:408-395-9253
Mailing Address - Fax:
Practice Address - Street 1:214 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-3201
Practice Address - Country:US
Practice Address - Phone:408-293-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 8587 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU49115Medicare UPIN