Healthcare Provider Details

I. General information

NPI: 1801293709
Provider Name (Legal Business Name): DEBRA A. SHIM, OD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 UNIVERSITY BLVD STE 102
JUPITER FL
33458-3102
US

IV. Provider business mailing address

451 UNIVERSITY BLVD STE 102
JUPITER FL
33458-3102
US

V. Phone/Fax

Practice location:
  • Phone: 561-625-4380
  • Fax: 561-625-3920
Mailing address:
  • Phone: 561-625-4380
  • Fax: 561-625-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3312
License Number StateFL

VIII. Authorized Official

Name: DR. DEBRA ANN SHIM
Title or Position: OWNER
Credential: O.D.
Phone: 561-625-4380