Individual
GINA C SHAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2322 E THOUSAND OAKS BLVD, THOUSAND OAKS, CA 91362-3206
(805) 557-1055
Mailing address
2322 E THOUSAND OAKS BLVD, THOUSAND OAKS, CA 91362-3206
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
12441T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0124410
—
CA
Enumeration date
09/14/2006
Last updated
06/04/2015
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