Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG002370 | PA |
NPI | 1013229418 |
---|---|
Provider Name | Dr. John Michael Shields |
First Address | Lower Burrell, PA 15068-2527 |
Second Address | Lower Burrell, PA 15068-2527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2010 |
Last Update Date | 02/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1026219810001 | (05) | PA |