Provider Demographics
NPI:1306975982
Name:SHILY, B G (OD)
Entity type:Individual
Prefix:
First Name:B
Middle Name:G
Last Name:SHILY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:B
Other - Middle Name:G
Other - Last Name:SHILY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:9100 WILSHIRE BLVD
Mailing Address - Street 2:509E
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3415
Mailing Address - Country:US
Mailing Address - Phone:310-271-3937
Mailing Address - Fax:310-271-3959
Practice Address - Street 1:9100 WILSHIRE BLVD
Practice Address - Street 2:STE 509E
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3419
Practice Address - Country:US
Practice Address - Phone:310-271-3937
Practice Address - Fax:310-271-3959
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8177T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU26404Medicare UPIN
CAOP8177Medicare PIN