Healthcare Provider Details

I. General information

NPI: 1023642048
Provider Name (Legal Business Name): AC OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 N FRUITLAND BLVD
SALISBURY MD
21801-7201
US

IV. Provider business mailing address

800 KIM DR
CAMBRIDGE MD
21613-3210
US

V. Phone/Fax

Practice location:
  • Phone: 410-341-7403
  • Fax:
Mailing address:
  • Phone: 443-786-6446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER EARL CARPENTER
Title or Position: OWNER
Credential: OD
Phone: 410-341-7403