Healthcare Provider Details

I. General information

NPI: 1598881476
Provider Name (Legal Business Name): COLUMBIA FAMILY EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12345 WAKE FOREST RD SUITE E
CLARKSVILLE MD
21029-1500
US

IV. Provider business mailing address

12345 WAKE FOREST RD SUITE E
CLARKSVILLE MD
21029-1500
US

V. Phone/Fax

Practice location:
  • Phone: 410-531-7507
  • Fax: 410-531-8655
Mailing address:
  • Phone: 410-531-7507
  • Fax: 410-531-8655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1214
License Number StateMD

VIII. Authorized Official

Name: DR. JAMES HESS JR.
Title or Position: OWNER
Credential: O.D.
Phone: 410-531-7507