Provider Demographics
NPI:1407952179
Name:SHIELDS, GEORGE B (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:B
Last Name:SHIELDS
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:1905 TOWNE CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3594
Practice Address - Country:US
Practice Address - Phone:410-268-8200
Practice Address - Fax:410-266-3996
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
547POtherPTAN
1316147184OtherGROUP NPI
1316229701OtherGROUP NPI
236068OtherPTAN