Healthcare Provider Details

I. General information

NPI: 1689697021
Provider Name (Legal Business Name): AHAVA OPPENHEIMER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12621 WATERSPOUT CT
OWINGS MILLS MD
21117-1028
US

IV. Provider business mailing address

7028 WALLIS AVE
BALTIMORE MD
21215-1711
US

V. Phone/Fax

Practice location:
  • Phone: 443-621-0756
  • Fax:
Mailing address:
  • Phone: 917-406-8264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006666
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberDA2274
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: