Active NPI
Dong Eok Shin
- Optician
- Riverside, CA
National Provider Identifier
1164075198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 70820
- Practice address
- 4250 Van Buren Blvd
Riverside, CA 92503-2602 - Phone
- (909) 964-9524
- NPI assigned
- Jul 18, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 70820 | CA | Primary |
Addresses
Primary practice location
4250 Van Buren Blvd
Riverside, CA 92503-2602
Mailing address
23684 Gold Nugget Ave
Diamond Bar, CA 91765-2335
Phone (213) 500-8292
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 70820 | CA | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| G Marcus Ford MD | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ophthalmology Physician
- Moreno Valley, CA
- NPI 1629663455
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674432000000",
"number": "1164075198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23684 GOLD NUGGET AVE",
"city": "DIAMOND BAR",
"state": "CA",
"postal_code": "917652335",
"telephone_number": "213-500-8292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4250 VAN BUREN BLVD",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925032602",
"telephone_number": "909-964-9524"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "DONG EOK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-18",
"last_updated": "2023-01-23",
"certification_date": "2023-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "CA",
"license": "70820",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.