Provider Demographics
NPI:1306272869
Name:DORSAM & GENERIE, OD, LLC
Entity type:Organization
Organization Name:DORSAM & GENERIE, OD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENERIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:443-420-8113
Mailing Address - Street 1:5725 RICHARDS VALLEY RD STE A9
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6964
Mailing Address - Country:US
Mailing Address - Phone:443-420-8113
Mailing Address - Fax:443-420-8113
Practice Address - Street 1:6230 OLD DOBBIN LN STE 190
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5954
Practice Address - Country:US
Practice Address - Phone:443-420-8113
Practice Address - Fax:443-973-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1997152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty