Healthcare Provider Details

I. General information

NPI: 1013057728
Provider Name (Legal Business Name): PAUL NENNER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5006 SINCLAIR LN
BALTIMORE MD
21206-5936
US

IV. Provider business mailing address

7012 YORK RD
BALTIMORE MD
21212-1511
US

V. Phone/Fax

Practice location:
  • Phone: 410-488-6800
  • Fax: 410-488-4270
Mailing address:
  • Phone: 410-294-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA0780
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTA0780
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberTA0780
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberTA0780
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberTA0780
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: