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General NPI Number Information
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NPI Number | 1376742270
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Entity Type | Organization
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Legal Business Name | PLATINUM EYES
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 45315 ALTON LN SUITE 16038
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City | CALIFORNIA
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State | MD
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Zip | 20619
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Country | US
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Telephone | 301-863-6950
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Fax | 301-863-6954
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Provider Business Mailing Address
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Address Line | 45315 ALTON LN SUITE 16038
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City | CALIFORNIA
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State | MD
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Zip | 20619
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Country | US
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Telephone | 301-863-6950
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Fax | 301-863-6954
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. DARRYL A SMITH
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Credential | OD
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Telephone | 301-863-6950
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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 | 18272823
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License Number State | MD
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