1356435572 NPI number — SELECT EYE CARE PA

Table of content: (NPI 1356435572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356435572 NPI number — SELECT EYE CARE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SELECT EYE CARE PA
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:
1356435572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8601 LASALLE RD
Provider Second Line Business Mailing Address:
108
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21286-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-821-6400
Provider Business Mailing Address Fax Number:
410-339-3846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8601 LASALLE RD
Provider Second Line Business Practice Location Address:
108
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21286-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-821-6400
Provider Business Practice Location Address Fax Number:
410-339-3846
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LABORWIT
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
410-821-6400

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA1383 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: D0050028 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: D0006791 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 366302700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: E689000 . This is a "BCBS CHOICE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: LS06 . This is a "BCBS OF MARYLAND" identifier , issued by the state of ( MP ) . This identifiers is of the category "OTHER".
  • Identifier: 845124900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 026421100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com