Basic Information
| Provider Information | |||||||||
| NPI: | 1275730491 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5701 GREENBELT RD | ||||||||
| Address2: | |||||||||
| City: | BERWYN HEIGHTS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207402257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013452053 | ||||||||
| FaxNumber: | 3015925070 | ||||||||
| Practice Location | |||||||||
| Address1: | 5701 GREENBELT RD | ||||||||
| Address2: | |||||||||
| City: | BERWYN HEIGHTS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207402257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109971800 | ||||||||
| FaxNumber: | 3015965070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MUND | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3013452053 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WS0006X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Sports Vision |
No ID Information.