Provider Demographics
NPI:1528065885
Name:BREGEL, CALVERT ROSS (OD)
Entity type:Individual
Prefix:DR
First Name:CALVERT
Middle Name:ROSS
Last Name:BREGEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1029 LIGHT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4017
Mailing Address - Country:US
Mailing Address - Phone:410-752-8208
Mailing Address - Fax:410-752-7144
Practice Address - Street 1:1029 LIGHT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4017
Practice Address - Country:US
Practice Address - Phone:410-752-8208
Practice Address - Fax:410-752-7144
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDX086Medicare PIN
MDU09056Medicare UPIN