Provider Demographics
NPI:1154570075
Name:JUMPERS MALL OPTICS, INC.
Entity type:Organization
Organization Name:JUMPERS MALL OPTICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:PREISS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-544-4441
Mailing Address - Street 1:8155 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6931
Mailing Address - Country:US
Mailing Address - Phone:410-544-4441
Mailing Address - Fax:410-544-4765
Practice Address - Street 1:8155 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6931
Practice Address - Country:US
Practice Address - Phone:410-544-4441
Practice Address - Fax:410-544-4765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD134237Medicare PIN