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General NPI Number Information
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NPI Number | 1124259718
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Entity Type | Organization
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Legal Business Name | ANCHOR EYECARE ANNAPOLIS
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 321 KINKAID RD BUILDING 329
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City | ANNAPOLIS
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State | MD
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Zip | 21402-1002
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Country | US
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Telephone | 410-757-8169
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Fax | 410-349-0079
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Provider Business Mailing Address
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Address Line | 701 PEARSON POINT PL
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City | ANNAPOLIS
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State | MD
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Zip | 21401-4577
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Country | US
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Telephone | 410-757-8169
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Fax | 410-349-0079
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | COLLEEN SHIELDS
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Credential |
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Telephone | 410-279-2286
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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 | MD1738
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License Number State | MD
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