Jisoo L Shin, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

T006053-1 Issued in NY

Practice address

971 Central Park Ave
Suite 5
Scarsdale, NY 10583-3211

Phone

(914) 723-7392

Fax

(914) 723-1004

NPI assigned

Mar 20, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• My Vision Care Corpation

  • Optometrist
  • Fort Lee, NJ
  • NPI 1689841470
  NPD (past)

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209945600000",
    "number": "1962527846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 HEATH PL",
            "city": "HASTINGS ON HUDSON",
            "state": "NY",
            "postal_code": "107063619",
            "telephone_number": "914-479-1578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 CENTRAL PARK AVE",
            "address_2": "SUITE 5",
            "city": "SCARSDALE",
            "state": "NY",
            "postal_code": "105833211",
            "telephone_number": "914-723-7392",
            "fax_number": "914-723-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "JISOO",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2008-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00549600",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27TO00087000",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "T006053-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Sepe Chepuru, LMSW
• Margot A Serwer, OTR/L
• Shalom Mental Health Counseling PLLC
• Leena Sharma, DDS, BDS, BSC, AEGD
• Rashmi C. Sheth, M.D.
• Sadie Rhea Shin, PHD
• Shaista Shiraz, FNP
• Danielle Lynn Shlomo, LCSW
• Kotoo Shoda, M.D.
• SHR Medical PC

• Optometrist in Scarsdale, NY
• Providers in Scarsdale, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.