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NPI Code Detail

MEDICARE: COLUMBIA FAMILY EYE CARE, INC.

MEDICARE: COLUMBIA FAMILY EYE CARE, 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
1152W00000XOptometristTA1214MD

General Provider Information

NPI Number : 1598881476
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLUMBIA FAMILY EYE CARE, INC.
Provider Business Mailing Address
First Line : 12345 WAKE FOREST RD
Second Line : SUITE E
City : CLARKSVILLE
State : MD
Zip : 21029-1500
Country : US
Telephone Number : 410-531-7507
Fax Number : 410-531-8655
Provider Business Practice Location Address
First Line : 12345 WAKE FOREST RD
Second Line : SUITE E
City : CLARKSVILLE
State : MD
Zip : 21029-1500
Country : US
Telephone Number : 410-531-7507
Fax Number : 410-531-8655
Authorized Official
Title or Position : OWNER
Name : DR. JAMES HESS JR.
Credential : O.D.
Telephone Number : 410-531-7507
Provider Enumeration Date : 03/22/2007
Last Update Date : 12/11/2012

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Directions to “COLUMBIA FAMILY EYE CARE, INC. ” Practice Location

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