Provider Demographics
NPI:1306848536
Name:SHIEL, CHARLES M (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:SHIEL
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 1:63 W PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1334
Mailing Address - Country:US
Mailing Address - Phone:201-845-4700
Mailing Address - Fax:201-845-4474
Practice Address - Street 1:63 W PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1334
Practice Address - Country:US
Practice Address - Phone:201-845-4700
Practice Address - Fax:201-845-4474
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00370200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8668995227OtherRETIRED RAILROAD MEDICARE
NJ8668995227OtherRETIRED RAILROAD MEDICARE
NJ557065Medicare PIN
NJ0423720001Medicare NSC