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General NPI Number Information
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NPI Number | 1033427679
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Entity Type | Organization
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Legal Business Name | CHASE EYE CARE
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 1812 PULASKI HWY SUITE A
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City | EDGEWOOD
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State | MD
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Zip | 21040-1697
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Country | US
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Telephone | 401-676-1010
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Fax | 443-922-7582
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Provider Business Mailing Address
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Address Line | 1812 PULASKI HWY SUITE A
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City | EDGEWOOD
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State | MD
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Zip | 21040-1697
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Country | US
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Telephone | 401-676-1010
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Fax | 443-922-7582
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SELVIN GNANAKKAN
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Credential | O.D.
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Telephone | 410-676-1010
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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 | 1769
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License Number State | MD
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