Healthcare Provider Details

I. General information

NPI: 1942425905
Provider Name (Legal Business Name): OPHTHALMIC PHOTOGRAPHY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 ENCLAVE CT
BALTIMORE MD
21208-3337
US

IV. Provider business mailing address

3131 ENCLAVE CT
BALTIMORE MD
21208-3337
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6533
  • Fax: 410-328-1178
Mailing address:
  • Phone: 410-328-6533
  • Fax: 410-328-1178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT A LISS
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 410-328-5934