Provider Demographics
NPI:1154400679
Name:BALTIMORE OPTICAL INC
Entity type:Organization
Organization Name:BALTIMORE OPTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-764-9360
Mailing Address - Street 1:6412 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-2308
Mailing Address - Country:US
Mailing Address - Phone:410-764-9360
Mailing Address - Fax:410-764-3229
Practice Address - Street 1:6412 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2308
Practice Address - Country:US
Practice Address - Phone:410-764-9360
Practice Address - Fax:410-764-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty