MEDICARE: DR KERAMATI & ASSOCIATES, 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	152W00000X	Optometrist	TA1937	MD

General Provider Information

NPI Number	:	1629115753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR KERAMATI & ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	10300 LITTLE PATUXENT PKWY
Second Line	:	SUITE 1630
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3341
Country	:	US
Telephone Number	:	410-730-1831
Fax Number	:

Provider Business Practice Location Address
First Line	:	10300 LITTLE PATUXENT PKWY
Second Line	:	SUITE 1630 - COLUMBIA MALL
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3341
Country	:	US
Telephone Number	:	410-730-1831
Fax Number	:	410-730-9860

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MEHRDAD KERAMATI
Credential	:	O.D.
Telephone Number	:	410-730-1831

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/20/2009

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