Healthcare Provider Details

I. General information

NPI: 1548281686
Provider Name (Legal Business Name): DEBROUSE OPTICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 1/2 HARFORD RD
BALTIMORE MD
21234-6401
US

IV. Provider business mailing address

7601 1/2 HARFORD RD
BALTIMORE MD
21234-6401
US

V. Phone/Fax

Practice location:
  • Phone: 410-444-2500
  • Fax: 410-444-2500
Mailing address:
  • Phone: 410-444-2500
  • Fax: 410-444-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number30249681
License Number StateMD

VIII. Authorized Official

Name: MR. ARNOLD TRETTON JR.
Title or Position: OPTICIAN/OWNER
Credential: FNAO
Phone: 410-444-2500