Provider Demographics
NPI:1649271164
Name:SHIFRIN, EUGENE (OD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:SHIFRIN
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 1:14269 N 87TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3695
Mailing Address - Country:US
Mailing Address - Phone:480-483-8882
Mailing Address - Fax:623-563-1413
Practice Address - Street 1:10619 N HAYDEN RD STE 101A
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-8510
Practice Address - Country:US
Practice Address - Phone:480-798-0733
Practice Address - Fax:480-563-1413
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ311856Medicaid
AZZ187078Medicare PIN
AZ311856Medicaid
AZZ164083Medicare PIN
AZZ162077Medicare PIN
AZZ164080Medicare PIN
AZZ164081Medicare PIN
AZZ162075Medicare PIN
AZZ164085Medicare PIN
AZZ164082Medicare PIN
AZZ162076Medicare PIN
AZZ162078Medicare PIN
AZZ162079Medicare PIN
AZZ162077Medicare PIN