MEDICARE: EDWARD E. SAUBLE, JR.

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	:	1427280023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD E. SAUBLE, JR.

Provider Business Mailing Address
First Line	:	6 ANTRIM ST
Second Line	:
City	:	TANEYTOWN
State	:	MD
Zip	:	21787-2237
Country	:	US
Telephone Number	:	410-751-1160
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 ANTRIM ST
Second Line	:
City	:	TANEYTOWN
State	:	MD
Zip	:	21787-2237
Country	:	US
Telephone Number	:	410-751-1160
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EDWARD E SAUBLE JR.
Credential	:	OD
Telephone Number	:	410-751-1160

Provider Enumeration Date	:	08/14/2009
Last Update Date	:	08/14/2009

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