1952593345 NPI number — OPTICALCARE

Table of content: (NPI 1952593345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952593345 NPI number — OPTICALCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTICALCARE
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:
1952593345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 121
Provider Business Mailing Address City Name:
GLEN BURNIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-761-0078
Provider Business Mailing Address Fax Number:
410-761-0353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 121
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-6902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-761-0078
Provider Business Practice Location Address Fax Number:
410-760-0353
Provider Enumeration Date:
08/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARTYN
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-761-0098

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  N/A ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 53281002 . This is a "MD PROVIDER NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com