Healthcare Provider Details

I. General information

NPI: 1467151696
Provider Name (Legal Business Name): COLUMBIA EYE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10015 OLD COLUMBIA RD STE J135
COLUMBIA MD
21046-1741
US

IV. Provider business mailing address

10015 OLD COLUMBIA RD STE J135
COLUMBIA MD
21046-1741
US

V. Phone/Fax

Practice location:
  • Phone: 410-381-1688
  • Fax: 410-381-3855
Mailing address:
  • Phone: 410-381-1688
  • Fax: 410-381-3855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER A COLEMAN
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 240-498-6768