MEDICARE: PASADENA EYE CARE, LLC

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

General Provider Information

NPI Number	:	1447766001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASADENA EYE CARE, LLC

Provider Business Mailing Address
First Line	:	33 MAGOTHY BEACH RD STE 104
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-4467
Country	:	US
Telephone Number	:	410-437-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 MAGOTHY BEACH RD STE 104
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-4467
Country	:	US
Telephone Number	:	410-437-6000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARTIN BLAKE
Credential	:
Telephone Number	:	410-437-6000

Provider Enumeration Date	:	12/19/2017
Last Update Date	:	12/19/2017

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Directions to “PASADENA EYE CARE, LLC ” Practice Location

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