Basic Information
| Provider Information | |||||||||
| NPI: | 1114355377 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SEIDENBERG PROTZKO EYE ASSOCIATES | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2023 PULASKI HWY | ||||||||
| Address2: | |||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210782137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109396477 | ||||||||
| FaxNumber: | 4109396555 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 E PULASKI HWY | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219216457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106203600 | ||||||||
| FaxNumber: | 4106203838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2013 | ||||||||
| LastUpdateDate: | 11/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRANDIS | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4109429476 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | TA1239 | MD | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.