1700801339 NPI number — DOCTORS ON SIGHT, OPTOMETRISTS, INC.

Table of content: (NPI 1700801339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700801339 NPI number — DOCTORS ON SIGHT, OPTOMETRISTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS ON SIGHT, OPTOMETRISTS, 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:
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:
1700801339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2955 CRAIN HIGHWAY
Provider Second Line Business Mailing Address:
SUITE A&B
Provider Business Mailing Address City Name:
WALDORF
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-843-1000
Provider Business Mailing Address Fax Number:
301-843-1919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2955 CRAIN HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE A&B
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-843-1000
Provider Business Practice Location Address Fax Number:
301-843-1919
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHWARTZBERG
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-843-1000

Provider Taxonomy Codes

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

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

  • Identifier: G00222 , issued by the state of ( DC ) . This identifiers is of the category "MEDICARE PIN".
  • Identifier: 0347220001 . This identifiers is of the category "MEDICARE NSC".
  • Identifier: 747L , issued by the state of ( MD ) . This identifiers is of the category "MEDICARE PIN".