Healthcare Provider Details

I. General information

NPI: 1952035206
Provider Name (Legal Business Name): PERSONALEYES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 REISTERSTOWN RD STE B
BALTIMORE MD
21208-1335
US

IV. Provider business mailing address

2529 FARRINGDON RD
BALTIMORE MD
21209-2547
US

V. Phone/Fax

Practice location:
  • Phone: 410-428-4182
  • Fax:
Mailing address:
  • Phone: 410-428-4182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM ZUCKERBROD
Title or Position: OWNER
Credential: OD
Phone: 410-864-2526