Provider Demographics
NPI:1124259718
Name:ANCHOR EYECARE ANNAPOLIS
Entity type:Organization
Organization Name:ANCHOR EYECARE ANNAPOLIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-279-2286
Mailing Address - Street 1:701 PEARSON POINT PL
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4577
Mailing Address - Country:US
Mailing Address - Phone:410-757-8169
Mailing Address - Fax:410-349-0079
Practice Address - Street 1:321 KINKAID RD
Practice Address - Street 2:BUILDING 329
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21402-1002
Practice Address - Country:US
Practice Address - Phone:410-757-8169
Practice Address - Fax:410-349-0079
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE B. SHIELDS, O.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-31
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD1738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1316147184OtherNPI
MD1407952179OtherNPI