=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265609358
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSSEX EYE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2008
-----------------------------------------------------
Last Update Date | 05/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32030 LONG NECK RD
-----------------------------------------------------
City | MILLSBORO
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19966-6228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-947-2020
-----------------------------------------------------
Fax | 302-947-1300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32030 LONG NECK RD
-----------------------------------------------------
City | MILLSBORO
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19966-6228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-947-2020
-----------------------------------------------------
Fax | 302-947-1300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CARL MASCHAUER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 302-856-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | I3-0001160
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------