Provider Demographics
NPI:1063761260
Name:TOWSON EYEGROUP LLC
Entity type:Organization
Organization Name:TOWSON EYEGROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-296-2224
Mailing Address - Street 1:825 GOUCHER BLVD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5602
Mailing Address - Country:US
Mailing Address - Phone:410-296-2224
Mailing Address - Fax:
Practice Address - Street 1:825 GOUCHER BLVD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5602
Practice Address - Country:US
Practice Address - Phone:410-296-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0792332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier