Provider Demographics
NPI:1972515120
Name:SHINNICK, DAN T (OD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:T
Last Name:SHINNICK
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 1:1200 E JACKSON AVE
Mailing Address - Street 2:SUITE B.
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1606
Mailing Address - Country:US
Mailing Address - Phone:956-682-1350
Mailing Address - Fax:
Practice Address - Street 1:1200 E JACKSON AVE
Practice Address - Street 2:SUITE B.
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1606
Practice Address - Country:US
Practice Address - Phone:956-682-1350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02506152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E25TOtherBCBS
TX00E25TMedicare PIN
TX00E25TOtherBCBS