MEDICARE: CATONSVILLE OPTICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1144411034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATONSVILLE OPTICAL

Provider Business Mailing Address
First Line	:	727 FREDERICK RD
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-4503
Country	:	US
Telephone Number	:	410-744-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	727 FREDERICK RD
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-4503
Country	:	US
Telephone Number	:	410-744-1111
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ERNEST SENGEBUSCH
Credential	:
Telephone Number	:	410-477-1111

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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Directions to “CATONSVILLE OPTICAL ” Practice Location

Language	Start Address	Practice Location

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