Provider Demographics
NPI:1902471477
Name:SHIM VISION GROUP INC
Entity Type:Organization
Organization Name:SHIM VISION GROUP INC
Other - Org Name:DALTON OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-278-6113
Mailing Address - Street 1:415 W CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-4267
Mailing Address - Country:US
Mailing Address - Phone:706-278-6113
Mailing Address - Fax:
Practice Address - Street 1:415 W CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-4267
Practice Address - Country:US
Practice Address - Phone:706-278-6113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty