MEDICARE: DR. NICHOLAS SCOTT SHILMAN 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	2986	MN

General Provider Information

NPI Number	:	1750373361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS SCOTT SHILMAN O.D.

Provider Business Mailing Address
First Line	:	1600 MILLER TRUNK HWY
Second Line	:	SUITE 429
City	:	DULUTH
State	:	MN
Zip	:	55811-5640
Country	:	US
Telephone Number	:	218-727-5457
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 MILLER TRUNK HWY
Second Line	:	SUITE 429
City	:	DULUTH
State	:	MN
Zip	:	55811-5640
Country	:	US
Telephone Number	:	218-727-5457
Fax Number	:

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	07/08/2007

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