Healthcare Provider Details

I. General information

NPI: 1881792190
Provider Name (Legal Business Name): HALPERN EYE CARE OF MARYLAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 REVOLUTION ST
HAVRE DE GRACE MD
21078-3718
US

IV. Provider business mailing address

920 REVOLUTION ST
HAVRE DE GRACE MD
21078-3718
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-2200
  • Fax: 410-939-5980
Mailing address:
  • Phone: 410-939-2200
  • Fax: 410-939-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL RYAN HALPERN
Title or Position: PRESIDENT/OWNER
Credential: O.D.
Phone: 410-939-2200