MEDICARE: DR. SHELDON D. DISKIN O.D.

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	TA0635	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X156	OTHER	MD	CARE FIRST
2	6803	OTHER	MD	CARE FIRST NATIONAL CAPIT

General Provider Information

NPI Number	:	1598816944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELDON D. DISKIN O.D.

Provider Business Mailing Address
First Line	:	7931 RITCHIE HWY
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-4343
Country	:	US
Telephone Number	:	410-768-8830
Fax Number	:	410-768-2219

Provider Business Practice Location Address
First Line	:	48 WATKINS PARK DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1628
Country	:	US
Telephone Number	:	301-249-5890
Fax Number	:	301-249-5892

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

Provider Enumeration Date	:	01/14/2007
Last Update Date	:	07/21/2016

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