Provider Demographics
NPI:1902973027
Name:SHINTANI, KELLY SHANA (OD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:SHANA
Last Name:SHINTANI
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 1:20 ORINDA WAY
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2519
Mailing Address - Country:US
Mailing Address - Phone:925-253-1320
Mailing Address - Fax:925-253-1939
Practice Address - Street 1:20 ORINDA WAY
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2519
Practice Address - Country:US
Practice Address - Phone:925-253-1320
Practice Address - Fax:925-253-1939
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11395T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487843652OtherGROUP NPI
CACI226ZOtherPTAN
U86646Medicare UPIN
CAZZZ01732ZMedicare PIN
CASD 0113951Medicare PIN