Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | ODT1339 | TN |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | ODT1339 | TN |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | ODT1339 | TN |
N | 152WP0200X | Pediatric Optomitrist | ODT1339 | TN |
N | 152WS0006X | Sports Vision | ODT1339 | TN |
N | 152WV0400X | Optomitrist - Vision Therapist | ODT1339 | TN |
N | 152WX0102X | Occupational Vision | ODT1339 | TN |
NPI | 1114085859 |
---|---|
Provider Name | Dr. Charles Y Shields |
First Address | Knoxville, TN 37922-3222 |
Second Address | Knoxville, TN 37922-3222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 26/10/2010 |