Healthcare Provider Details

I. General information

NPI: 1245236868
Provider Name (Legal Business Name): DAVID JOEL FELDMANN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 FREDERICK RD STE 101
CATONSVILLE MD
21228-4779
US

IV. Provider business mailing address

3703 THOROUGHBRED LN
OWINGS MILLS MD
21117-1252
US

V. Phone/Fax

Practice location:
  • Phone: 410-747-1221
  • Fax:
Mailing address:
  • Phone: 410-581-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA0745
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: