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General NPI Number Information
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NPI Number | 1013689975
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Entity Type | Individual
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Provider Name | COLIN KANE OD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 600 N WOLFE STREET WILMER 233
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City | BALTIMORE
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State | MD
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Zip | 21287
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Country | US
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Telephone | 410-955-8679
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Fax | 410-614-9240
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Provider Business Mailing Address
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Address Line | 10 N GREENE STREET OPTOMETRY CLINIC
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City | BALTIMORE
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State | MD
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Zip | 21201
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Country | US
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Telephone | 443-655-2810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA2830
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License Number State | MD
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