Healthcare Provider Details

I. General information

NPI: 1003024795
Provider Name (Legal Business Name): CHANNING VISION EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 BAUGHMANS LANE
FREDERICK MD
21702-4083
US

IV. Provider business mailing address

166 BAUGHMANS LANE
FREDERICK MD
21702-4083
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-1177
  • Fax:
Mailing address:
  • Phone: 301-663-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP593
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001617
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000256
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002831
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA0967
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. EUGENE STEPHAN CHANNING
Title or Position: PRESIDENT
Credential: OD
Phone: 301-663-1177