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General NPI Number Information
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NPI Number | 1316229701
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Entity Type | Organization
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Legal Business Name | SHIELDS VISION
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 321 KINKAID RD BUILDING 329
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City | ANNAPOLIS
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State | MD
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Zip | 21402-1002
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Country | US
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Telephone | 410-757-8169
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Fax |
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Provider Business Mailing Address
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Address Line | 701 PEARSON POINT PL
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City | ANNAPOLIS
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State | MD
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Zip | 21401-4577
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Country | US
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Telephone | 410-279-7627
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Fax | 443-458-0497
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | COLLEEN SHIELDS
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Credential |
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Telephone | 410-279-7627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA1738
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License Number State | MD
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