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General NPI Number Information
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NPI Number | 1518090315
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Entity Type | Organization
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Legal Business Name | CARL K. SHIN, M.D., INC.
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 2141 MENTOR AVE
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City | PAINESVILLE
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State | OH
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Zip | 44077-1323
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Country | US
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Telephone | 440-354-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 2141 MENTOR AVE
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City | PAINESVILLE
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State | OH
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Zip | 44077-1323
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARL SHIN
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Credential |
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Telephone | 440-354-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 35043576
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License Number State | OH
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