Provider Demographics
NPI:1093828436
Name:SHINI, SIMAAN (OD)
Entity type:Individual
Prefix:DR
First Name:SIMAAN
Middle Name:
Last Name:SHINI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 LONGMIRE DR STE K
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5281
Mailing Address - Country:US
Mailing Address - Phone:979-694-2000
Mailing Address - Fax:
Practice Address - Street 1:1796 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-9610
Practice Address - Country:US
Practice Address - Phone:979-694-2000
Practice Address - Fax:979-694-2010
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6652TG152W00000X
TX6652 TG152WP0200X, 152WS0006X, 152WX0102X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6652 TGOtherLICENSE
TX81343QOtherBCBS ID
TX81343QOtherBCBS ID
TX81343QOtherBCBS ID
TX8D2584Medicare ID - Type UnspecifiedMEDICARE ID
TXV04010Medicare UPIN
P01081605Medicare PIN