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NPI Code Detail

MEDICARE: CARL K. SHIN, M.D., INC.

MEDICARE: CARL K. SHIN, M.D., INC.
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
1207W00000XOphthalmology Physician35043576OH

General Provider Information

NPI Number : 1538450440
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARL K. SHIN, M.D., INC.
Provider Business Mailing Address
First Line : 2141 MENTOR AVE
Second Line :
City : PAINESVILLE
State : OH
Zip : 44077-1323
Country : US
Telephone Number : 440-354-6900
Fax Number : 449-354-6400
Provider Business Practice Location Address
First Line : 2141 MENTOR AVE
Second Line :
City : PAINESVILLE
State : OH
Zip : 44077-1323
Country : US
Telephone Number : 440-354-6900
Fax Number : 449-354-6400
Authorized Official
Title or Position : PRESIDENT
Name : DR. CARL K SHIN
Credential : M.D.
Telephone Number : 440-354-6900
Provider Enumeration Date : 04/26/2011
Last Update Date : 04/26/2011

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