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General NPI Number Information
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NPI Number | 1912399692
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Entity Type | Organization
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Legal Business Name | INNOVISION EYE CARE LLC
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 1500 WHETSTONE WAY STE 100
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City | BALTIMORE
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State | MD
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Zip | 21230-4765
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Country | US
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Telephone | 443-300-7296
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Fax | 443-288-2250
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Provider Business Mailing Address
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Address Line | 1500 WHETSTONE WAY STE 100
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City | BALTIMORE
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State | MD
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Zip | 21230-4765
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Country | US
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Telephone | 443-300-7296
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Fax | 443-288-2250
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SHILPA JAIN
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Credential | OD
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Telephone | 443-300-7296
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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 | TA2323
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License Number State | MD
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