1639231491 NPI number — IRWIN AZMAN O.D. AND THOMAS AZMAN O.D.

Table of content: (NPI 1639231491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639231491 NPI number — IRWIN AZMAN O.D. AND THOMAS AZMAN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRWIN AZMAN O.D. AND THOMAS AZMAN O.D.
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:
AZMAN EYE CARE SPECIALISTS
Provider Other Organization Name Type Code:
3
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:
1639231491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 CENTER PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNDALK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21222-4304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-285-3900
Provider Business Mailing Address Fax Number:
410-285-5084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 CENTER PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNDALK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21222-4304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-285-3900
Provider Business Practice Location Address Fax Number:
410-285-5084
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AZMAN
Authorized Official First Name:
IRWIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
410-561-8050

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  719 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 678 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 515 , 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)





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