Provider Demographics
NPI:1285889329
Name:CHESAPEAKE EYE CENTER, P.A.
Entity type:Organization
Organization Name:CHESAPEAKE EYE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-749-1191
Mailing Address - Street 1:105 PINE BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7160
Mailing Address - Country:US
Mailing Address - Phone:410-749-1191
Mailing Address - Fax:
Practice Address - Street 1:1414 S SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7127
Practice Address - Country:US
Practice Address - Phone:410-749-1191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESAPEAKE EYE CENTER, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-17
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD792118700Medicaid