Provider Demographics
NPI:1962536896
Name:PENINSULA EYE CENTER, P.A.
Entity type:Organization
Organization Name:PENINSULA EYE CENTER, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:LUPPENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-749-9290
Mailing Address - Street 1:101 MILFORD ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6952
Mailing Address - Country:US
Mailing Address - Phone:410-749-9290
Mailing Address - Fax:410-543-9087
Practice Address - Street 1:101 MILFORD ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6952
Practice Address - Country:US
Practice Address - Phone:410-749-9290
Practice Address - Fax:410-543-9087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022099332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH788PEOtherCAREFIRST BLUE CROSS BLUE
MD08435300-01OtherDMERC
MD44689OtherDAVIS VISION