Active NPI
Shin Lee, OD
- Optometrist
- Oakland, CA
National Provider Identifier
1255903795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 35010
- Practice address
- 491 30TH St Ste 201
Oakland, CA 94609-3235 - Phone
- (510) 836-2122
- Fax
- (510) 836-3773
- NPI assigned
- Jul 14, 2021
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 35010 | CA | Primary |
Addresses
Primary practice location
491 30TH St Ste 201
Oakland, CA 94609-3235
Mailing address
2383 N Main St
Walnut Creek, CA 94596-3549
Phone (530) 220-4500
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 |
|---|---|---|---|
| 35010 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680480000000",
"number": "1255903795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2383 N MAIN ST",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945963549",
"telephone_number": "530-220-4500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "491 30TH ST STE 201",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946093235",
"telephone_number": "510-836-2122",
"fax_number": "510-836-3773"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SHIN",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-14",
"last_updated": "2023-04-03",
"certification_date": "2023-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "35010",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 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.