Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | OPC5324 | FL |
Y | 152WP0200X | Pediatric Optomitrist | 33802 | CA |
N | 152WS0006X | Sports Vision | 33802 | CA |
N | 152WV0400X | Optomitrist - Vision Therapist | 33802 | CA |
N | 152WV0400X | Optomitrist - Vision Therapist | OPT33802 | CA |
NPI | 1013457464 |
---|---|
Provider Name | Dr. Shawn M Joseph |
First Address | Encino, CA 91316-5236 |
Second Address | Encino, CA 91316-5236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2017 |
Last Update Date | 02/01/2022 |