Active NPI
Lysle Shaw-McMinn, O.D.
- Optometrist
- Riverside, CA
National Provider Identifier
1720481641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 15133
- Practice address
- 16327 Sally LN
Riverside, CA 92504-5639 - Phone
- (951) 672-4971
- NPI assigned
- Oct 6, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 | 15133 | CA | Primary |
Addresses
Primary practice location
16327 Sally LN
Riverside, CA 92504-5639
Mailing address
16327 Sally LN
Riverside, CA 92504-5639
Phone (951) 672-4971
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160411001588 | CA | Practitioner - Optometry | 1355649112 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787270400000",
"number": "1720481641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16327 SALLY LN",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925045639",
"telephone_number": "951-672-4971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16327 SALLY LN",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925045639",
"telephone_number": "951-672-4971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW-MCMINN",
"first_name": "LYSLE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-06",
"last_updated": "2026-08-21",
"certification_date": "2026-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "15133",
"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 Aug 21, 2026; 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.