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General NPI Number Information
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NPI Number | 1639179112
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Entity Type | Organization
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Legal Business Name | BARENBURG OPTICAL SERVICE, INC
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Dates
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Enumeration Date | 07/27/2005
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 100 PARK AVE
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City | BALTIMORE
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State | MD
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Zip | 21201-3416
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Country | US
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Telephone | 410-752-1677
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Fax | 410-752-4435
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Provider Business Mailing Address
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Address Line | 100 PARK AVE
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City | BALTIMORE
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State | MD
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Zip | 21201-3416
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Country | US
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Telephone | 410-752-1677
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Fax | 410-752-4435
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK B GORDON
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Credential | OD
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Telephone | 410-752-1677
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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 | TA0633
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License Number State | MD
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