1003024795 NPI number — CHANNING VISION EYE CARE INC

Table of content: (NPI 1003024795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003024795 NPI number — CHANNING VISION EYE CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHANNING VISION EYE CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR EUGENE S CHANNING PRACTICE OF OPTOMETRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003024795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
166 BAUGHMANS LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21702-4083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-663-1177
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 BAUGHMANS LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-663-1177
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHANNING
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
STEPHAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-663-1177

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA0967 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: OP593 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OEG001617 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 0618000256 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 002831 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: KANGCH . This is a "CAREFIRST BC BS" identifier . This identifiers is of the category "OTHER".




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