Provider Demographics
NPI:1316147184
Name:GEORGE B. SHIELDS, O.D., P.C.
Entity type:Organization
Organization Name:GEORGE B. SHIELDS, O.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-757-8169
Mailing Address - Street 1:701 PEARSON POINT PL
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4577
Mailing Address - Country:US
Mailing Address - Phone:410-757-8169
Mailing Address - Fax:443-458-0497
Practice Address - Street 1:321 KINKAID RD
Practice Address - Street 2:BUILDING 329
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21402-1002
Practice Address - Country:US
Practice Address - Phone:410-757-8169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1124259718OtherNPI
MD1407952179OtherINDIVIDUAL NPI
MD1538390224OtherNPI
DC173796OtherPTAN
DC173796OtherPTAN