Provider Demographics
NPI:1659355642
Name:SHILLING, DAVID ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:SHILLING
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 1:111 CLOUGH ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2901
Mailing Address - Country:US
Mailing Address - Phone:419-352-3223
Mailing Address - Fax:419-352-5485
Practice Address - Street 1:111 CLOUGH ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2901
Practice Address - Country:US
Practice Address - Phone:419-352-3223
Practice Address - Fax:419-352-5485
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4313/T112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03172OtherPARAMOUNT HMO PROVIDER #
OH0840835Medicaid
OH03172OtherPARAMOUNT HMO PROVIDER #
OH0840835Medicaid