=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346107232
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHESAPEAKE EYE CARE AND LASER CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2026
-----------------------------------------------------
Last Update Date | 01/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8601 LA SALLE RD STE 108
-----------------------------------------------------
City | TOWSON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21286-2005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-821-6400
-----------------------------------------------------
Fax | 410-296-4722
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2661 RIVA RD STE 1030
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-7131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-571-8733
-----------------------------------------------------
Fax | 410-571-6309
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | JENNIFER EMINIZER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 667-354-5528
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------