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General NPI Number Information
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NPI Number | 1598408379
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Entity Type | Organization
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Legal Business Name | ELDERSBURG EYE CARE, LLC
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 5957 EXCHANGE DR STE 114
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City | ELDERSBURG
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State | MD
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Zip | 21784-9260
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Country | US
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Telephone | 814-322-8776
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Fax |
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Provider Business Mailing Address
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Address Line | 471 HAWKRIDGE LN
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City | SYKESVILLE
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State | MD
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Zip | 21784-7637
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Country | US
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Telephone | 814-322-8776
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MELANIE C RENNIE
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Credential | OD
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Telephone | 814-322-8776
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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 |
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License Number State |
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