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General NPI Number Information
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NPI Number | 1194122333
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Entity Type | Organization
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Legal Business Name | ALL EYES ON US OPTICS INC
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 2495 ANNAPOLIS MALL
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7613
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Country | US
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Telephone | 410-916-3261
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Fax |
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Provider Business Mailing Address
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Address Line | 5924 FENWICK AVE
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City | BALTIMORE
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State | MD
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Zip | 21239-2406
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Country | US
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Telephone | 410-916-3261
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LOLITA PENN
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Credential | OPTICIAN
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Telephone | 410-916-3261
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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 | TA1219
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License Number State | MD
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