Provider Demographics
NPI:1447452420
Name:SHIH, GLENNA WEI (OD)
Entity type:Individual
Prefix:
First Name:GLENNA
Middle Name:WEI
Last Name:SHIH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 N GARFIELD AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:616 N GARFIELD AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1141
Practice Address - Country:US
Practice Address - Phone:626-572-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10970T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU67940Medicare UPIN