Healthcare Provider Details

I. General information

NPI: 1053507236
Provider Name (Legal Business Name): PENN OPTICAL CO. LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 E MONUMENT ST
BALTIMORE MD
21205-2334
US

IV. Provider business mailing address

5006 SINCLAIR LN
BALTIMORE MD
21206-5936
US

V. Phone/Fax

Practice location:
  • Phone: 410-327-7070
  • Fax: 410-327-7072
Mailing address:
  • Phone: 410-488-6800
  • Fax: 410-488-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RICHARD BRADLEY FUSS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 410-327-7070