Provider Demographics
NPI:1871618470
Name:SHINEN, TAMMY CHANG (O D)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:CHANG
Last Name:SHINEN
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N ROSE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3939
Mailing Address - Country:US
Mailing Address - Phone:714-528-2566
Mailing Address - Fax:714-993-5369
Practice Address - Street 1:1201 N ROSE DR STE 100
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3939
Practice Address - Country:US
Practice Address - Phone:714-961-5386
Practice Address - Fax:714-464-4166
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11956T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABH853ZMedicare PIN