Healthcare Provider Details

I. General information

NPI: 1164370052
Provider Name (Legal Business Name): TINA SHAFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 BOLLINGER CANYON RD STE 1104
SAN RAMON CA
94583-2305
US

IV. Provider business mailing address

6000 BOLLINGER CANYON RD STE 1104
SAN RAMON CA
94583-2305
US

V. Phone/Fax

Practice location:
  • Phone: 925-725-1745
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: