Provider Demographics
NPI:1972863975
Name:SHIELDS EYE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SHIELDS EYE ASSOCIATES, LLC
Other - Org Name:IMPRESSIONS EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-964-8701
Mailing Address - Street 1:13209 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3609
Mailing Address - Country:US
Mailing Address - Phone:240-929-4255
Mailing Address - Fax:
Practice Address - Street 1:3300 CRAIN HWY
Practice Address - Street 2:VISION CENTER
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1398
Practice Address - Country:US
Practice Address - Phone:301-805-8238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty