Provider Demographics
NPI:1386729713
Name:SHUI, MARY ANN CHEN (OD)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:CHEN
Last Name:SHUI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45584 CHEROKEE LN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-6820
Mailing Address - Country:US
Mailing Address - Phone:408-278-2020
Mailing Address - Fax:
Practice Address - Street 1:1101 S WINCHESTER BLVD STE E156
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3903
Practice Address - Country:US
Practice Address - Phone:408-244-8700
Practice Address - Fax:408-244-9560
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11806-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00812724Medicare PIN
CAAR420Medicare PIN