1902013824 NPI number — PENN OPTICAL CO. LTD

Table of content: (NPI 1902013824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902013824 NPI number — PENN OPTICAL CO. LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENN OPTICAL CO. LTD
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:
1902013824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5006 SINCLAIR LN
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:
21206-5936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-488-6800
Provider Business Mailing Address Fax Number:
410-488-4270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5006 SINCLAIR LN
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:
21206-5936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-488-6800
Provider Business Practice Location Address Fax Number:
410-488-4270
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FUSS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
BRADLEY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-488-6800

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WX0102X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , 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: 792848300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 687720600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 754302600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 281428500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050678800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 789538100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050698200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 265668000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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