=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942311576
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEANNA RENEE LINGENFELTER O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1811 MONOCACY BLVD
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21701-4728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-644-2456
-----------------------------------------------------
Fax | 301-644-2458
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1242 MORGAN STATION RD
-----------------------------------------------------
City | WOODBINE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21797-8724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-788-5497
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | TA1823
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------