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General NPI Number Information
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NPI Number | 1679465041
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Entity Type | Organization
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Legal Business Name | CHESAPEAKE EYE CARE AND LASER CENTER, LLC
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 3110 LORD BALTIMORE DR STE 103
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City | BALTIMORE
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State | MD
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Zip | 21244-2644
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Country | US
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Telephone | 410-277-3937
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Fax | 410-281-9388
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Provider Business Mailing Address
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Address Line | 2661 RIVA RD STE 1030
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7131
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Country | US
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Telephone | 410-571-8733
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | KRISTA WALLECH
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Credential |
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Telephone | 443-228-6971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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