Healthcare Provider Details

I. General information

NPI: 1790032290
Provider Name (Legal Business Name): VISIONARY EYE CARE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10995 OWINGS MILLS BLVD SUITE 204
OWINGS MILLS MD
21117-1030
US

IV. Provider business mailing address

10995 OWINGS MILLS BLVD SUITE 204
OWINGS MILLS MD
21117-1030
US

V. Phone/Fax

Practice location:
  • Phone: 410-363-0060
  • Fax: 410-363-0911
Mailing address:
  • Phone: 410-363-0060
  • Fax: 410-363-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA-1751
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTA-1751
License Number StateMD

VIII. Authorized Official

Name: DR. BRIAN M. GRANEK
Title or Position: PRESIDENT
Credential: O.D.
Phone: 410-363-0060