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General NPI Number Information
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NPI Number | 1962536896
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Entity Type | Organization
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Legal Business Name | PENINSULA EYE CENTER, P.A.
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 MILFORD ST
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City | SALISBURY
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State | MD
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Zip | 21804-6952
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Country | US
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Telephone | 410-749-9290
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Fax | 410-543-9087
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Provider Business Mailing Address
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Address Line | 101 MILFORD ST
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City | SALISBURY
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State | MD
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Zip | 21804-6952
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Country | US
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Telephone | 410-749-9290
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Fax | 410-543-9087
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY PHILIP LUPPENS
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Credential | M.D.
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Telephone | 410-749-9290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | D0022099
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License Number State | MD
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