Provider Demographics
NPI:1508041104
Name:GEORGE S SHIELDS OD, PC
Entity Type:Organization
Organization Name:GEORGE S SHIELDS OD, PC
Other - Org Name:SHIELDS FAMILY EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-749-8300
Mailing Address - Street 1:3545 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-7015
Mailing Address - Country:US
Mailing Address - Phone:405-749-8300
Mailing Address - Fax:405-749-8307
Practice Address - Street 1:3545 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-7015
Practice Address - Country:US
Practice Address - Phone:405-749-8300
Practice Address - Fax:405-749-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29598152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty