Healthcare Provider Details

I. General information

NPI: 1932421419
Provider Name (Legal Business Name): VSA ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 FOREST DR STE A
ANNAPOLIS MD
21401-3868
US

IV. Provider business mailing address

2331 FOREST DR STE A
ANNAPOLIS MD
21401-3868
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-8908
  • Fax: 410-224-0871
Mailing address:
  • Phone: 410-224-8908
  • Fax: 410-224-0871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1587
License Number StateMD

VIII. Authorized Official

Name: DR. SHARON LYNN MAGILL
Title or Position: PRESIDENT
Credential: O.D.
Phone: 410-224-8908