MEDICARE: BRIAN SHIH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	15261	CA
2	152W00000X	Optometrist	878	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D4552188	OTHER	CA	CALIFORNIA DMV (DRIVER'S LICENSE)
2	878	OTHER	NV	NEVADA OPTOMETRY LICENSE

General Provider Information

NPI Number	:	1306220082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN SHIH O.D.

Provider Business Mailing Address
First Line	:	5599 OAK BEND DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1227
Country	:	US
Telephone Number	:	310-310-1953
Fax Number	:

Provider Business Practice Location Address
First Line	:	4388 E CRAIG RD STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-1962
Country	:	US
Telephone Number	:	702-643-9191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/21/2022

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