Provider Demographics
NPI:1598816944
Name:DISKIN, SHELDON D (OD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:D
Last Name:DISKIN
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 1:7931 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4343
Mailing Address - Country:US
Mailing Address - Phone:410-768-8830
Mailing Address - Fax:410-768-2219
Practice Address - Street 1:48 WATKINS PARK DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1628
Practice Address - Country:US
Practice Address - Phone:301-249-5890
Practice Address - Fax:301-249-5892
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDX156OtherCARE FIRST
MD6803OtherCARE FIRST NATIONAL CAPIT
MD6803OtherCARE FIRST NATIONAL CAPIT
MDX156OtherCARE FIRST