Provider Demographics
NPI:1194893370
Name:CHESTERTOWN OPTICAL SHOPPE INC
Entity type:Organization
Organization Name:CHESTERTOWN OPTICAL SHOPPE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RABINOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-778-9089
Mailing Address - Street 1:932 WASHINGTON AVE
Mailing Address - Street 2:UNIT G
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-3324
Mailing Address - Country:US
Mailing Address - Phone:410-778-9089
Mailing Address - Fax:410-778-5617
Practice Address - Street 1:932 WASHINGTON AVE
Practice Address - Street 2:UNIT G
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-3324
Practice Address - Country:US
Practice Address - Phone:410-778-9089
Practice Address - Fax:410-778-5617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD530852-01 X758OtherCAREFIRST ID#S
MD530852-01 X758OtherCAREFIRST ID#S