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General NPI Number Information
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NPI Number | 1861683872
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Entity Type | Organization
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Legal Business Name | EYE TO EYE OF FREDERICK INC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 2060 YELLOW SPRINGS RD STE 104
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City | FREDERICK
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State | MD
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Zip | 21702-2322
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Country | US
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Telephone | 301-695-8771
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Fax | 301-695-1616
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Provider Business Mailing Address
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Address Line | 2060 YELLOW SPRINGS RD STE 104
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City | FREDERICK
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State | MD
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Zip | 21702-2322
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Country | US
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Telephone | 301-695-8771
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Fax | 301-695-1616
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN CHADO
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Credential | O.D.
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Telephone | 301-695-8771
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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 | TA 858
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License Number State | MD
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