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General NPI Number Information
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NPI Number | 1770616294
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Entity Type | Organization
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Legal Business Name | TD-ANNAPOLIS INC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 2331A FOREST DR
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3833
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Country | US
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Telephone | 410-224-8852
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Fax | 410-224-0871
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Provider Business Mailing Address
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Address Line | 5900 GREENBELT RD
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City | GREENBELT
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State | MD
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Zip | 20770-1010
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Country | US
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Telephone | 301-982-4200
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Fax | 301-441-1093
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GERALD LEE THOMPSON
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Credential | O.D.
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Telephone | 301-982-4200
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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 | TA0900
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License Number State | MD
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