Healthcare Provider Details

I. General information

NPI: 1649472549
Provider Name (Legal Business Name): EYE 4 KIDS VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10461 MILL RUN CIR STE 100
OWINGS MILLS MD
21117-5535
US

IV. Provider business mailing address

10461 MILL RUN CIR STE 100
OWINGS MILLS MD
21117-5535
US

V. Phone/Fax

Practice location:
  • Phone: 410-581-0505
  • Fax: 410-581-0580
Mailing address:
  • Phone: 410-581-0505
  • Fax: 410-581-0580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1479
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTA1479
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberTA1479
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberTA1479
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberTA1479
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberTA1479
License Number StateMD

VIII. Authorized Official

Name: MRS. JODIE S SCHWARTZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-581-0505