Healthcare Provider Details

I. General information

NPI: 1093181158
Provider Name (Legal Business Name): PEARL SHIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10826 OLD MILL RD STE 101
OMAHA NE
68154-2660
US

IV. Provider business mailing address

10826 OLD MILL RD STE 101
OMAHA NE
68154-2660
US

V. Phone/Fax

Practice location:
  • Phone: 402-898-3232
  • Fax:
Mailing address:
  • Phone: 402-898-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4285
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1554
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3698
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2167
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD61030676
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberR-310
License Number StateAL
# 7
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0003163
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: