Healthcare Provider Details

I. General information

NPI: 1013834217
Provider Name (Legal Business Name): DAVID OLUTOMI ADEYEYE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 LORD BALTIMORE DR STE 103
BALTIMORE MD
21244-2644
US

IV. Provider business mailing address

2104 PEACEFUL WAY APT 203
ODENTON MD
21113-3249
US

V. Phone/Fax

Practice location:
  • Phone: 410-277-3937
  • Fax:
Mailing address:
  • Phone: 410-236-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA3153
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: