Healthcare Provider Details

I. General information

NPI: 1942604608
Provider Name (Legal Business Name): GLOBAL COMPLEX EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 YORK ROAD SUITE 100
TIMONIUM MD
21093-3140
US

IV. Provider business mailing address

2219 YORK ROAD SUITE 100
TIMONIUM MD
21093-3140
US

V. Phone/Fax

Practice location:
  • Phone: 410-660-2646
  • Fax:
Mailing address:
  • Phone: 410-660-2646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NICOLE ELLINGSWORTH
Title or Position: ADMINISTRATOR
Credential: CPO
Phone: 410-660-2646