1578647764 NPI number — LEE D. CAPLAN O.D., INC.

Table of content: (NPI 1578647764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578647764 NPI number — LEE D. CAPLAN O.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEE D. CAPLAN O.D., 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:
1578647764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8134 LIBERTY RD
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:
21244-3044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-521-2197
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8134 LIBERTY RD
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:
21244-3044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-521-2197
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAPLAN
Authorized Official First Name:
LEE
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OPTOMETRIST / OWNER
Authorized Official Telephone Number:
410-521-2197

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA0835 , 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: 53553301 . This is a "CAREFIRST BC/BS RENDERING" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6902000000X583 . This is a "BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 219011 . This is a "ADVANTICA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 10093 . This is a "EHP JOHNS HOPKINS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 181 . This is a "BALTO CITY VISION CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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