Provider Demographics
NPI:1275532467
Name:SHILMAN, NATHANIEL DEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:DEAN
Last Name:SHILMAN
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 1:2273 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-2605
Mailing Address - Country:US
Mailing Address - Phone:701-225-7886
Mailing Address - Fax:701-225-8148
Practice Address - Street 1:2273 3RD AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2605
Practice Address - Country:US
Practice Address - Phone:701-225-7886
Practice Address - Fax:701-225-8148
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60600Medicaid
ND60600Medicaid