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General NPI Number Information
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NPI Number | 1629115753
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Entity Type | Organization
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Legal Business Name | DR KERAMATI & ASSOCIATES, INC.
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/20/2009
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Provider Practice Location Address
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Address Line | 10300 LITTLE PATUXENT PKWY SUITE 1630 - COLUMBIA MALL
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City | COLUMBIA
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State | MD
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Zip | 21044-3341
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Country | US
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Telephone | 410-730-1831
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Fax | 410-730-9860
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Provider Business Mailing Address
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Address Line | 10300 LITTLE PATUXENT PKWY SUITE 1630
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City | COLUMBIA
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State | MD
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Zip | 21044-3341
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Country | US
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Telephone | 410-730-1831
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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. MEHRDAD KERAMATI
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Credential | O.D.
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Telephone | 410-730-1831
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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 | TA1937
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License Number State | MD
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