Provider Demographics
NPI:1962553818
Name:EYECARE PROFESSIONALS P C
Entity type:Organization
Organization Name:EYECARE PROFESSIONALS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:NAVIN
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:240-420-8888
Mailing Address - Street 1:101 EASTERN BLVD N
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5978
Mailing Address - Country:US
Mailing Address - Phone:240-420-8888
Mailing Address - Fax:240-420-8400
Practice Address - Street 1:101 EASTERN BLVD N
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5978
Practice Address - Country:US
Practice Address - Phone:240-420-8888
Practice Address - Fax:240-420-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU32577Medicare UPIN
135MMedicare PIN
MD4464240001Medicare NSC