1265677579 NPI number — KREIGER EYE INSTITUTE

Table of content: (NPI 1265677579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265677579 NPI number — KREIGER EYE INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KREIGER EYE INSTITUTE
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:
6
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:
1265677579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 W BELVEDERE AVE
Provider Second Line Business Mailing Address:
CREDENTIALING
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21215-5216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-601-5523
Provider Business Mailing Address Fax Number:
410-601-8946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 QUARRY LAKE DR
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21209-3742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-601-2020
Provider Business Practice Location Address Fax Number:
410-601-5137
Provider Enumeration Date:
12/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COHN
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER/OPTICIAN
Authorized Official Telephone Number:
410-601-2020

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  30-062 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0586700006 . This is a "MEDICARE NSC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com