MEDICARE: DR. IRWIN AZMAN O.D.

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	719	MD
2	152WC0802X	Corneal and Contact Management Optometrist	TA0719	MD

General Provider Information

NPI Number	:	1558437590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRWIN AZMAN O.D.

Provider Business Mailing Address
First Line	:	2219 YORK RD 100
Second Line	:
City	:	TIMONIUM
State	:	MD
Zip	:	21093-3140
Country	:	US
Telephone Number	:	410-561-6071
Fax Number	:	410-415-1691

Provider Business Practice Location Address
First Line	:	2219 YORK RD 100
Second Line	:
City	:	TIMONIUM
State	:	MD
Zip	:	21093-3140
Country	:	US
Telephone Number	:	410-561-6071
Fax Number	:	410-415-1691

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	03/01/2016

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