MEDICARE: KIMBERLY SHIH O.D., INC

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	OPT12857T	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WOP12857C	OTHER	CA	MEDICARE INDIVIDUAL PTAN

General Provider Information

NPI Number	:	1851431878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY SHIH O.D., INC

Provider Business Mailing Address
First Line	:	1727 FULLERTON RD
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2614
Country	:	US
Telephone Number	:
Fax Number	:	626-529-0927

Provider Business Practice Location Address
First Line	:	1727 FULLERTON RD
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2614
Country	:	US
Telephone Number	:	626-581-4600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIMBERLY SHIH
Credential	:	O.D.
Telephone Number	:	626-581-4600

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/21/2009

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