Healthcare Provider Details

I. General information

NPI: 1912942632
Provider Name (Legal Business Name): CINDY DEUTSCH KASNER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6412 REISTERSTOWN RD
BALTIMORE MD
21215-2308
US

IV. Provider business mailing address

515 FAIRMOUNT AVE CREDENTIALING DEPARTMENT
TOWSON MD
21286-5466
US

V. Phone/Fax

Practice location:
  • Phone: 410-764-9360
  • Fax: 410-764-3228
Mailing address:
  • Phone: 410-494-1324
  • Fax: 410-494-1361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1208
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: