MEDICARE: EDWARD E SAUBLE JR. OD

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	152W00000X	Optometrist	TA0844	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	X653EE	OTHER	MD	CAREFIRST
4	402409-02	OTHER	MD	CAREFIRST
5	LX71LO	OTHER	MD	CAREFIRST

General Provider Information

NPI Number	:	1174511885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD E SAUBLE JR. OD

Provider Business Mailing Address
First Line	:	6 ANTRIM ST
Second Line	:
City	:	TANEYTOWN
State	:	MD
Zip	:	21787-2237
Country	:	US
Telephone Number	:	410-751-1160
Fax Number	:	410-756-2530

Provider Business Practice Location Address
First Line	:	6 ANTRIM ST
Second Line	:
City	:	TANEYTOWN
State	:	MD
Zip	:	21787-2237
Country	:	US
Telephone Number	:	410-756-1160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	09/17/2020

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