MEDICARE: CHARLES M SHIEL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	27OA00370200	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8668995227	OTHER	NJ	RETIRED RAILROAD MEDICARE

General Provider Information

NPI Number	:	1306848536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES M SHIEL OD

Provider Business Mailing Address
First Line	:	63 W PLEASANT AVE
Second Line	:
City	:	MAYWOOD
State	:	NJ
Zip	:	07607-1334
Country	:	US
Telephone Number	:	201-845-4700
Fax Number	:	201-845-4474

Provider Business Practice Location Address
First Line	:	63 W PLEASANT AVE
Second Line	:
City	:	MAYWOOD
State	:	NJ
Zip	:	07607-1334
Country	:	US
Telephone Number	:	201-845-4700
Fax Number	:	201-845-4474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/12/2011

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Directions to “ CHARLES M SHIEL OD” Practice Location

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