Provider Demographics
NPI:1316229701
Name:SHIELDS VISION
Entity Type:Organization
Organization Name:SHIELDS VISION
Other - Org Name:ANCHOR EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-279-7627
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:410-279-7627
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:2011-09-13
Last Update Date:2013-05-01
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
MD230444Medicare PIN