Provider Demographics
NPI:1245585694
Name:SHIELDS, ASHLEY RAE (OD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:RAE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:RAE
Other - Last Name:LYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2315 MAPLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2028
Mailing Address - Country:US
Mailing Address - Phone:740-453-1611
Mailing Address - Fax:740-450-7680
Practice Address - Street 1:2315 MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701
Practice Address - Country:US
Practice Address - Phone:740-453-1611
Practice Address - Fax:740-450-7680
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6142152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1053390401OtherMEDICARE GROUP NPI
OH1245585694Medicare PIN