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General NPI Number Information
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NPI Number | 1225453020
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Entity Type | Organization
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Legal Business Name | DR K EYECARE INC
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Dates
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Enumeration Date | 03/03/2014
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 8765 CENTRE PARK DR STE 13
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City | COLUMBIA
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State | MD
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Zip | 21045-2385
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Country | US
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Telephone | 443-631-4461
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Fax |
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Provider Business Mailing Address
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Address Line | 8765 CENTRE PARK DR STE 13
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City | COLUMBIA
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State | MD
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Zip | 21045-2385
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Country | US
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Telephone | 443-631-4461
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Fax |
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Authorized Official
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Title or Position | OD
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Name | MEHRDAD KERAMATI
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Credential | MD
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Telephone | 443-631-4461
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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 | TA1937
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License Number State | MD
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