Provider Demographics
NPI:1801293709
Name:DEBRA A. SHIM, OD, PA
Entity type:Organization
Organization Name:DEBRA A. SHIM, OD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
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 STE 102
Mailing Address - Street 2:
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 STE 102
Practice Address - Street 2:
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:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3312152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1134455736Medicare UPIN