Healthcare Provider Details

I. General information

NPI: 1790906378
Provider Name (Legal Business Name): APOSTOLOS JOHN GIANNAS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7106 RIDGE RD SUITE 130
BALTIMORE MD
21237-3875
US

IV. Provider business mailing address

38 MITCHELL DR.
ABINGDON MD
21009-1629
US

V. Phone/Fax

Practice location:
  • Phone: 410-866-2022
  • Fax: 410-866-2031
Mailing address:
  • Phone: 410-569-0163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA0814
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTA0814
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: