Healthcare Provider Details

I. General information

NPI: 1790090009
Provider Name (Legal Business Name): LINDSAY T CIOCCO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY T GIBNEY O.D.

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 ANNAPOLIS RD SUITE 290
ODENTON MD
21113-1637
US

IV. Provider business mailing address

1106 ANNAPOLIS RD SUITE 290
ODENTON MD
21113-1637
US

V. Phone/Fax

Practice location:
  • Phone: 410-874-1425
  • Fax: 410-874-1429
Mailing address:
  • Phone: 410-874-1425
  • Fax: 410-874-1429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2298
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: