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General NPI Number Information
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NPI Number | 1447770540
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Entity Type | Organization
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Legal Business Name | CLEAR VISION EYECARE LLC
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 06/21/2017
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Provider Practice Location Address
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Address Line | 10801 HICKORY RIDGE RD STE 200
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City | COLUMBIA
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State | MD
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Zip | 21044-3871
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Country | US
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Telephone | 410-997-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 7721 OLD WOODSTOCK LN
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-6980
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Country | US
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Telephone | 201-400-2113
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | HETAL RANA
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Credential | OD
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Telephone | 201-400-2113
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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 | TA2038
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License Number State | MD
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