David Sung Shin, O.D.

Primary specialty

Low Vision Rehabilitation OptometristTaxonomy code 152WL0500X

License

12779T Issued in CA

Practice address

15923 Bear Valley Rd
Ste B100
Hesperia, CA 92345-1762

Phone

(909) 980-5552

NPI assigned

Feb 13, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Vision Express Optometry

  • Optometrist
  • Fontana, CA
  • NPI 1932482551
  NPD (past) Authorized official
• Eyellusion Vision Center Incorporated

  • Optician
  • Woodside, NY
  • NPI 1245261593
  NPD (past)
• Eyellusion Vision Center Incorporated

  • Optician
  • Plainview, NY
  • NPI 1952852360
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569283200000",
    "number": "1245372200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15923 BEAR VALLEY RD",
            "address_2": "STE B100",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923451762",
            "telephone_number": "909-200-6479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15923 BEAR VALLEY RD",
            "address_2": "STE B100",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923451762",
            "telephone_number": "909-980-5552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "DAVID",
        "middle_name": "SUNG",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2019-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12779T",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "CA",
            "license": "12779T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0127790",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jalpan Manharlal Shah, D.D.S., M.D.S.
• Aparna Sharma, M.D.
• Mojgan Sheikhavandi, DDS
• Willard Ray Shell
• Barbara Shepard
• Shirell'S Home Care Changing Lives LLC
• Janice Shore
• Richard Scott Sible, RADL
• Daniel Jerico Sihombing, RD
• Estela Silva

• Low Vision Rehabilitation Optometrist in Hesperia, CA
• Providers in Hesperia, CA by specialty
• Low Vision Rehabilitation Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.