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General NPI Number Information
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NPI Number | 1104822899
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Entity Type | Individual
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Provider Name | RICHARD CRAIG EDLOW O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 07/06/2012
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Provider Practice Location Address
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Address Line | 611 FREDERICK RD STE 101
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City | CATONSVILLE
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State | MD
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Zip | 21228-4779
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Country | US
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Telephone | 410-747-1221
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Fax |
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Provider Business Mailing Address
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Address Line | 8913 GRIFFIN WAY
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City | PIKESVILLE
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State | MD
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Zip | 21208-1424
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Country | US
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Telephone | 410-602-3126
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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 | TA0787
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License Number State | MD
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