Basic Information
Provider Information | |||||||||
NPI: | 1144401530 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HALPERN EYE CARE OF MARYLAND, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 920 REVOLUTION ST | ||||||||
Address2: |   | ||||||||
City: | HAVRE DE GRACE | ||||||||
State: | MD | ||||||||
PostalCode: | 210783748 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4109392200 | ||||||||
FaxNumber: | 4109395980 | ||||||||
Practice Location | |||||||||
Address1: | 5 BEL AIR SOUTH PKWY | ||||||||
Address2: | SUITE 117 | ||||||||
City: | BEL AIR | ||||||||
State: | MD | ||||||||
PostalCode: | 210156091 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4105690500 | ||||||||
FaxNumber: | 4105690502 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/14/2007 | ||||||||
LastUpdateDate: | 09/30/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HALPERN | ||||||||
AuthorizedOfficialFirstName: | SAMUEL | ||||||||
AuthorizedOfficialMiddleName: | RYAN | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
AuthorizedOfficialTelephone: | 3023461520 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | HALPERN EYE CARE OF MARYLAND, INC. | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | O. D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |   |
No ID Information.