MEDICARE: BALTIMORE OPTICAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1154400679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALTIMORE OPTICAL INC

Provider Business Mailing Address
First Line	:	6412 REISTERSTOWN RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-2308
Country	:	US
Telephone Number	:	410-764-9360
Fax Number	:	410-764-3229

Provider Business Practice Location Address
First Line	:	6412 REISTERSTOWN RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-2308
Country	:	US
Telephone Number	:	410-764-9360
Fax Number	:	410-764-3229

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ALLA DELLER
Credential	:
Telephone Number	:	410-764-9360

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	09/05/2012

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Directions to “BALTIMORE OPTICAL INC ” Practice Location

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