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General NPI Number Information
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NPI Number | 1972825388
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Entity Type | Individual
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Provider Name | EUGENE STEPHAN CHANNING O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 166 BAUGHMAN'S LANE CHANNING VISION-EYE CARE, INC.
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City | FREDERICK
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State | MD
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Zip | 21702-4083
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Country | US
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Telephone | 301-663-1177
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Fax |
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Provider Business Mailing Address
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Address Line | 166 BAUGHMAN'S LANE CHANNING VISION-EYE CARE, INC.
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City | FREDERICK
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State | MD
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Zip | 21702-4083
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Country | US
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Telephone | 301-663-1177
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | TAO967
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618000256
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OP593
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG001617
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00280800
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License Number State | NJ
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Taxonomy #6
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002831
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License Number State | NY
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