Healthcare Provider Details

I. General information

NPI: 1205814795
Provider Name (Legal Business Name): STANLEY ALLEN FEINBLUM O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MARLBORO AVE SUITE 31
EASTON MD
21601-2765
US

IV. Provider business mailing address

210 MARLBORO AVE SUITE 31
EASTON MD
21601-2765
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-3937
  • Fax: 410-822-2652
Mailing address:
  • Phone: 410-822-3937
  • Fax: 410-822-2652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA0663
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: