Provider Demographics
NPI:1902996358
Name:SANDRA SHINA HOU OD PC
Entity Type:Organization
Organization Name:SANDRA SHINA HOU OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:SHINA
Authorized Official - Last Name:HOU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-852-0445
Mailing Address - Street 1:2059 CATTAIL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3820
Mailing Address - Country:US
Mailing Address - Phone:248-852-0445
Mailing Address - Fax:248-852-0445
Practice Address - Street 1:2001 W MAPLE RD
Practice Address - Street 2:WAL-MART VISION CENTER
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7100
Practice Address - Country:US
Practice Address - Phone:248-435-4126
Practice Address - Fax:248-435-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004170152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty