1215123401 NPI number — PENN OPTICAL CO LTD

Table of content: (NPI 1215123401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215123401 NPI number — PENN OPTICAL CO LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENN OPTICAL CO LTD
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:
Provider Other Organization Name Type Code:
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:
1215123401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5006 SINCLAIR LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21206-5936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-488-6800
Provider Business Mailing Address Fax Number:
410-488-4270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 LIBERTY HEIGHTS AVE # 3730
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21215-8019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-669-8030
Provider Business Practice Location Address Fax Number:
410-669-7366
Provider Enumeration Date:
09/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FUSS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-488-6800

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WX0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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