Provider Demographics
NPI:1386809945
Name:FREDERICKTOWNE EYE CARE
Entity type:Organization
Organization Name:FREDERICKTOWNE EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HIGINBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-663-8858
Mailing Address - Street 1:467 W PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4805
Mailing Address - Country:US
Mailing Address - Phone:301-663-8858
Mailing Address - Fax:301-663-8871
Practice Address - Street 1:467 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4805
Practice Address - Country:US
Practice Address - Phone:301-663-8858
Practice Address - Fax:301-663-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1174332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDX385Medicare PIN
0797360001Medicare NSC
U36333Medicare UPIN