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General NPI Number Information
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NPI Number | 1700135761
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Entity Type | Organization
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Legal Business Name | CATONSVILLE EYE ASSOCIATES LLC
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 704B N ROLLING RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-4135
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Country | US
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Telephone | 410-788-7113
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Fax | 410-788-3241
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Provider Business Mailing Address
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Address Line | 704B N ROLLING RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-4135
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Country | US
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Telephone | 410-788-7113
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Fax | 410-788-3241
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Authorized Official
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Title or Position | MANAGER
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Name | MS. CAROLINE PHOEBUS
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Credential |
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Telephone | 410-788-7113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | TA0599
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License Number State | MD
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