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General NPI Number Information
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NPI Number | 1881850808
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Entity Type | Individual
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Provider Name | CHUN-CHIEH JACK SHIH O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 03/21/2020
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Provider Practice Location Address
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Address Line | 1679 S AZUSA AVE
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-3832
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Country | US
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Telephone | 626-810-0858
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Fax | 626-810-1308
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Provider Business Mailing Address
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Address Line | 16170 LEFFINGWELL RD STE 7
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City | WHITTIER
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State | CA
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Zip | 90603-3170
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Country | US
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Telephone | 562-947-6789
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Fax | 562-947-5688
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 13565
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License Number State | CA
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