Healthcare Provider Details

I. General information

NPI: 1912372434
Provider Name (Legal Business Name): EYE CARE ASSOCIATES OF MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7602 BELAIR RD
BALTIMORE MD
21236-4088
US

IV. Provider business mailing address

1838 GREENE TREE RD SUITE 200
PIKESVILLE MD
21208-6391
US

V. Phone/Fax

Practice location:
  • Phone: 410-821-5333
  • Fax: 410-663-0205
Mailing address:
  • Phone: 410-486-1010
  • Fax: 443-940-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0008334
License Number StateMD

VIII. Authorized Official

Name: MS. SUE KING
Title or Position: PRACTICE MANAGER
Credential:
Phone: 410-486-1010