Healthcare Provider Details

I. General information

NPI: 1487899928
Provider Name (Legal Business Name): DR. ALEXANDER C. NNABUE & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10228 LAKE ARBOR WAY
MITCHELLVILLE MD
20721-3113
US

IV. Provider business mailing address

317 HAVILAND MILL RD
BROOKEVILLE MD
20833-2312
US

V. Phone/Fax

Practice location:
  • Phone: 301-324-9500
  • Fax: 301-324-9502
Mailing address:
  • Phone: 301-325-9500
  • Fax: 301-325-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTA1277
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberTA1277
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberTA1277
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberTA1277
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1277
License Number StateMD

VIII. Authorized Official

Name: DR. PATRICIA PARKS
Title or Position: BILLING MANAGER
Credential:
Phone: 517-231-4086