MEDICARE: GLOBAL COMPLEX EYE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152WC0802X	Corneal and Contact Management Optometrist
2	152WL0500X	Low Vision Rehabilitation Optometrist
3	152W00000X	Optometrist

General Provider Information

NPI Number	:	1942604608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOBAL COMPLEX EYE CARE LLC

Provider Business Mailing Address
First Line	:	2219 YORK ROAD
Second Line	:	SUITE 100
City	:	TIMONIUM
State	:	MD
Zip	:	21093-3140
Country	:	US
Telephone Number	:	410-660-2646
Fax Number	:

Provider Business Practice Location Address
First Line	:	2219 YORK ROAD
Second Line	:	SUITE 100
City	:	TIMONIUM
State	:	MD
Zip	:	21093-3140
Country	:	US
Telephone Number	:	410-660-2646
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NICOLE ELLINGSWORTH
Credential	:	CPO
Telephone Number	:	410-660-2646

Provider Enumeration Date	:	10/09/2014
Last Update Date	:	03/02/2016

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