Provider Demographics
NPI:1992485817
Name:SHIMUNOV, NINA (OD)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:SHIMUNOV
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 1:1777 KUSER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3703
Mailing Address - Country:US
Mailing Address - Phone:609-581-5755
Mailing Address - Fax:609-581-7055
Practice Address - Street 1:1777 KUSER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-3703
Practice Address - Country:US
Practice Address - Phone:609-581-5755
Practice Address - Fax:609-581-7055
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00722100152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy