MEDICARE: PENN OPTICAL CO LTD

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	152WP0200X	Pediatric Optometrist
3	152WS0006X	Sports Vision Optometrist
4	152WX0102X	Occupational Vision Optometrist
5	152W00000X	Optometrist

General Provider Information

NPI Number	:	1952597155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENN OPTICAL CO LTD

Provider Business Mailing Address
First Line	:	5006 SINCLAIR LN
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21206-5936
Country	:	US
Telephone Number	:	410-488-6800
Fax Number	:	410-488-4270

Provider Business Practice Location Address
First Line	:	6901 SECURITY BLVD
Second Line	:	SUITE 405
City	:	BALTIMORE
State	:	MD
Zip	:	21244-2412
Country	:	US
Telephone Number	:	410-944-7709
Fax Number	:	410-944-0223

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD FUSS
Credential	:	O.D.
Telephone Number	:	410-488-6800

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	09/20/2007

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Directions to “PENN OPTICAL CO LTD ” Practice Location

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