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General NPI Number Information
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NPI Number | 1588857379
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Entity Type | Organization
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Legal Business Name | ALLEGANY OPTICAL LLC
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 1305 W 7TH ST STE. 15A
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City | FREDERICK
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State | MD
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Zip | 21702-4100
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Country | US
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Telephone | 301-695-4855
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Fax | 301-695-4870
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Provider Business Mailing Address
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Address Line | 1305 W 7TH ST STE. 15A
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City | FREDERICK
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State | MD
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Zip | 21702-4100
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Country | US
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Telephone | 301-695-4855
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Fax | 301-695-4870
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Authorized Official
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Title or Position | O.D. / MANAGING MEMBER
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Name | DR. JAMES J WHITELOCK
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Credential | O.D.
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Telephone | 717-263-2389
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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 | 10236876
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License Number State | MD
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