Healthcare Provider Details

I. General information

NPI: 1780235820
Provider Name (Legal Business Name): CHESAPEAKE EYE CARE & LASER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON HEIGHTS MED CTR
WESTMINSTER MD
21157-5633
US

IV. Provider business mailing address

2002 MEDICAL PKWY STE 320
ANNAPOLIS MD
21401-7901
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-4095
  • Fax:
Mailing address:
  • Phone: 410-571-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA C SCOTT
Title or Position: OWNER
Credential: MD
Phone: 410-571-7998