MEDICARE: SHINI OD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	6652TG	TX

General Provider Information

NPI Number	:	1083862213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHINI OD PA

Provider Business Mailing Address
First Line	:	3525 LONGMIRE DR STE K
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-5281
Country	:	US
Telephone Number	:	979-694-2000
Fax Number	:	979-694-2010

Provider Business Practice Location Address
First Line	:	3525 LONGMIRE DR STE K
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-5281
Country	:	US
Telephone Number	:	979-694-2000
Fax Number	:	979-694-2010

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	SIMAAN SHINI
Credential	:	O.D.
Telephone Number	:	979-694-2000

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	05/14/2014

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Directions to “SHINI OD PA ” Practice Location

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