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General NPI Number Information
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NPI Number | 1174856645
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Entity Type | Organization
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Legal Business Name | LIFEBRIDGE INVESTMENTS
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 750 MAIN ST SUITE 301A
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City | REISTERSTOWN
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State | MD
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Zip | 21136-2515
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Country | US
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Telephone | 410-526-3060
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Fax | 410-526-3091
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Provider Business Mailing Address
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Address Line | 2401 W BELVEDERE AVE CREDENTIALING
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City | BALTIMORE
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State | MD
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Zip | 21215-5216
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Country | US
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Telephone | 410-601-5523
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SUZANNE BEASLEY THOMAS
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Credential |
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Telephone | 410-494-1212
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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 | TA1490
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License Number State | MD
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