Individual provider Active NPI

Anne N. Shin, O.D.

  • Optometrist
  • N Hollywood, CA
National Provider Identifier
1679742241
Registry record updated Jun 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT 12595 Issued in CA
Practice address
5269 Lankershim Blvd
N Hollywood, CA 91601-3111
Phone
(818) 769-2024
NPI assigned
Feb 27, 2008
Last updated
Jun 10, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT 12595 CA Primary

Addresses

Primary practice location

5269 Lankershim Blvd
N Hollywood, CA 91601-3111

Mailing address

1247 19TH St
Hermosa Beach, CA 90254-3309
Phone (213) 709-3170

Other practice location 1

19636 Sherman Way
Reseda, CA 91335-3647
Phone (818) 774-2020

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250220002956 CA Practitioner - Optometry 8022538032 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2004
Medicare assignment
May accept Medicare assignment
Group practices
Valley Optometry Eyecare Center, Inc.Group PAC ID 3173678588, 3 clinicians

Practice addresses (Care Compare)

19636 Sherman Way
Reseda, CA 91335-3647
Phone (347) 724-1528

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT 12595CAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
El Portal Optometry, Inc Optometrist CurrentSince Mar 1, 2025 Accepting new patients
Valley Optometry Eyecare Center, Inc. Optometrist CurrentSince Mar 1, 2025 Accepting new patients
Clear Vision Optometry, Inc. Optometrist PastSince Mar 1, 2025 Accepting new patients
Robert H Teagle Jr Optometric Corp Optometrist PastSince Apr 5, 2017 Accepting new patients

Locations

5269 Lankershim Blvd
North Hollywood, CA 91601
Phone (818) 769-2020

19636 Sherman Way
Reseda, CA 91335
Phone (347) 724-1528

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781049600000",
    "number": "1679742241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1247 19TH ST",
            "city": "HERMOSA BEACH",
            "state": "CA",
            "postal_code": "902543309",
            "telephone_number": "213-709-3170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5269 LANKERSHIM BLVD",
            "city": "N HOLLYWOOD",
            "state": "CA",
            "postal_code": "916013111",
            "telephone_number": "818-769-2024"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19636 Sherman Way",
            "address_purpose": "LOCATION",
            "city": "Reseda",
            "state": "CA",
            "postal_code": "913353647",
            "country_code": "US",
            "telephone_number": "818-774-2020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIN",
        "first_name": "ANNE",
        "middle_name": "N.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-27",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 12595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in N Hollywood, CA

Sources for this page

Verify at the official NPI Registry.