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General NPI Number Information
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NPI Number | 1487857835
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Entity Type | Organization
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Legal Business Name | RANDALLSTOWN FAMILY EYE CARE LLC
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 07/26/2012
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Provider Practice Location Address
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Address Line | 5310 OLD COURT RD STE 103
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5243
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Country | US
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Telephone | 410-922-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 5310 OLD COURT RD STE 103
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5243
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Country | US
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Telephone | 410-922-2020
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC YARDLEY WALKER
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Credential | OD
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Telephone | 410-922-2020
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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 | TA1000
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License Number State | MD
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