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General NPI Number Information
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NPI Number | 1003276825
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Entity Type | Organization
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Legal Business Name | SEIDENBERG PROTZKO EYE ASSOCIATES
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 120 SPEER RD STE 1
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City | CHESTERTOWN
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State | MD
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Zip | 21620-1085
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Country | US
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Telephone | 410-939-6477
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Fax |
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Provider Business Mailing Address
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Address Line | 2023 PULASKI HWY
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-2137
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Country | US
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Telephone | 410-939-6477
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Fax |
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Authorized Official
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Title or Position | OPTICAL DIRECTOR
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Name | DR. DAVID D REED
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Credential | O.D.
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Telephone | 410-939-6477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | TA1239
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License Number State | MD
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