Healthcare Provider Details

I. General information

NPI: 1164520292
Provider Name (Legal Business Name): BENNY PO-YOUNG SHAO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 SARATOGA AVE STE 213
SAN JOSE CA
95129-3413
US

IV. Provider business mailing address

960 SARATOGA AVE STE 213
SAN JOSE CA
95129-3413
US

V. Phone/Fax

Practice location:
  • Phone: 408-837-7380
  • Fax: 408-516-0800
Mailing address:
  • Phone: 408-837-7380
  • Fax: 408-516-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11741
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number11741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: