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General NPI Number Information
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NPI Number | 1538338454
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Entity Type | Organization
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Legal Business Name | DR. CHARLES M SHIEL
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 106 W PLEASANT AVE
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City | MAYWOOD
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State | NJ
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Zip | 07607-1336
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Country | US
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Telephone | 201-487-6176
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Fax | 201-368-7905
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Provider Business Mailing Address
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Address Line | 106 W PLEASANT AVE
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City | MAYWOOD
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State | NJ
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Zip | 07607-1336
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Country | US
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Telephone | 201-487-6176
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Fax | 201-368-7905
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. CHARLES M SHIEL
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Credential | OD
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Telephone | 201-487-6176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 270A00370200
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License Number State | NJ
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