Provider Demographics
NPI:1609056852
Name:SHIELDS, TARA SUZANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:SUZANNE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43927 15TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4758
Mailing Address - Country:US
Mailing Address - Phone:661-948-6310
Mailing Address - Fax:611-948-6880
Practice Address - Street 1:43927 15TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4758
Practice Address - Country:US
Practice Address - Phone:661-948-6310
Practice Address - Fax:611-948-6880
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13444152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist