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General NPI Number Information
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NPI Number | 1134455736
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Entity Type | Organization
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Legal Business Name | DEBRA A. SHIM, O.D., P.A.
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 451 UNIVERSITY BLVD SUITE 102
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City | JUPITER
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State | FL
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Zip | 33458-3102
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Country | US
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Telephone | 561-625-4380
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Fax | 561-625-3920
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Provider Business Mailing Address
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Address Line | 451 UNIVERSITY BLVD SUITE 102
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City | JUPITER
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State | FL
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Zip | 33458-3102
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Country | US
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Telephone | 561-625-4380
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Fax | 561-625-3920
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DEBRA A SHIM
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Credential | O.D.
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Telephone | 561-625-4380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 3312
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License Number State | FL
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