MEDICARE: CHESAPEAKE EYE CARE & LASER CENTER LLC

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	156FX1800X	Optician

General Provider Information

NPI Number	:	1801436050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESAPEAKE EYE CARE & LASER CENTER LLC

Provider Business Mailing Address
First Line	:	220 CHAMPION DR STE 100
Second Line	:
City	:	HAGERSTOWN
State	:	MD
Zip	:	21740-6665
Country	:	US
Telephone Number	:	301-791-0888
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 CHAMPION DR STE 100
Second Line	:
City	:	HAGERSTOWN
State	:	MD
Zip	:	21740-6665
Country	:	US
Telephone Number	:	301-791-0888
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA C SCOTT
Credential	:	MD
Telephone Number	:	410-571-7998

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	01/15/2020

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