Healthcare Provider Details

I. General information

NPI: 1831907229
Provider Name (Legal Business Name): CHESAPEAKE EYE CARE & LASER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 LORD BALTIMORE DR
BALTIMORE MD
21244-2869
US

IV. Provider business mailing address

2661 RIVA RD STE 1030
ANNAPOLIS MD
21401-7131
US

V. Phone/Fax

Practice location:
  • Phone: 410-277-3937
  • Fax: 410-281-9388
Mailing address:
  • Phone: 410-571-8733
  • Fax: 410-571-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CREDENTIALING SPECIALIST
Title or Position: PROVIDER CREDENTIALING SPECIALIST
Credential:
Phone: 410-571-8733