Provider Demographics
NPI:1104808930
Name:MCMUNN, ELIZABETH C (OD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:C
Last Name:MCMUNN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:SUE
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:695 KINKAID RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21402-1006
Mailing Address - Country:US
Mailing Address - Phone:410-293-4378
Mailing Address - Fax:
Practice Address - Street 1:695 KINKAID RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21402-1006
Practice Address - Country:US
Practice Address - Phone:410-293-4378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002594152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT090002594CT01OtherANTHEM PROVIDER NUMBER
CT2584969OtherUNITED
CT7280400OtherAETNA PROVIDER NUMBER
CTP3655173OtherOXFORD
CT025940OtherCONNECTICARE PROVIDER NUM
CT205205873OtherTRICARE
CT2447250OtherCIGNA
CT2447250OtherCIGNA
CT205205873OtherTRICARE
CTOP2052OtherEYEMED
CT205205873OtherTRICARE