Basic Information
| Provider Information | |||||||||
| NPI: | 1306254941 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYEFIT VISION CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2111 VAN DEMAN STREET | ||||||||
| Address2: | 2NC FLOOR | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438960710 | ||||||||
| FaxNumber: | 6123670841 | ||||||||
| Practice Location | |||||||||
| Address1: | 7550 TEAGUE ROAD | ||||||||
| Address2: | SUITE 114 | ||||||||
| City: | HANOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107998067 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2014 | ||||||||
| LastUpdateDate: | 07/28/2014 | ||||||||
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| AuthorizedOfficialLastName: | ATKINS | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS OPERATIONS SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 4438960710 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SPECIALTY BENEFITS, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TA2031 | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.