1326053075 NPI number — ACCURATE OPTICAL CO OF KENT ISLAND INC

Table of content: (NPI 1326053075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326053075 NPI number — ACCURATE OPTICAL CO OF KENT ISLAND INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCURATE OPTICAL CO OF KENT ISLAND 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:
1326053075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31519 WINTERPLACE PARKWAY
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-749-1545
Provider Business Mailing Address Fax Number:
410-742-3707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 KENT LANDING
Provider Second Line Business Practice Location Address:
KENT LANDING SHOPPING CENTER
Provider Business Practice Location Address City Name:
STEVENSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-643-3355
Provider Business Practice Location Address Fax Number:
410-604-0266
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRANKLIN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
410-749-1545

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA 1972 , 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: 690901900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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