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General NPI Number Information
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NPI Number | 1235493396
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Entity Type | Organization
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Legal Business Name | CHESAPEAKE BAY OPTICAL LLC
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 07/03/2012
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Provider Practice Location Address
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Address Line | 2003 MEDICAL PKWY SUITE G90
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7992
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Country | US
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Telephone | 410-841-1909
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Fax | 410-571-8624
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Provider Business Mailing Address
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Address Line | 2003 MEDICAL PKWY SUITE G90
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7992
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Country | US
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Telephone | 410-841-1909
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Fax | 410-571-8624
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Authorized Official
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Title or Position | COOWNER
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Name | SANDRA D BRUTHER
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Credential |
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Telephone | 410-841-1909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 02526333
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License Number State | MD
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