Provider Demographics
NPI:1750373361
Name:SHILMAN, NICHOLAS SCOTT (OD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:SCOTT
Last Name:SHILMAN
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 1:1600 MILLER TRUNK HWY
Mailing Address - Street 2:SUITE 429
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-5640
Mailing Address - Country:US
Mailing Address - Phone:218-727-5457
Mailing Address - Fax:
Practice Address - Street 1:1600 MILLER TRUNK HWY
Practice Address - Street 2:SUITE 429
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-5640
Practice Address - Country:US
Practice Address - Phone:218-727-5457
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2986152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU02630Medicare UPIN