MEDICARE: DR. SIMAAN SHINI O.D.

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
2	152WP0200X	Pediatric Optometrist	6652 TG	TX
3	152WS0006X	Sports Vision Optometrist	6652 TG	TX
4	152WX0102X	Occupational Vision Optometrist	6652 TG	TX
5	152WC0802X	Corneal and Contact Management Optometrist	6652 TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6652 TG	OTHER	TX	LICENSE
2	81343Q	OTHER	TX	BCBS ID

General Provider Information

NPI Number	:	1093828436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMAAN SHINI O.D.

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	:

Provider Business Practice Location Address
First Line	:	1796 GRAHAM RD
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-9610
Country	:	US
Telephone Number	:	979-694-2000
Fax Number	:	979-694-2010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. SIMAAN SHINI O.D.” Practice Location

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