Basic Information
| Provider Information | |||||||||
| NPI: | 1316128705 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HALPERN EYE CARE OF MARYLAND, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 REVOLUTION ST | ||||||||
| Address2: | |||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210783748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109392200 | ||||||||
| FaxNumber: | 4109395980 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 NEWPORT DR | ||||||||
| Address2: | SUITE J | ||||||||
| City: | FOREST HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210501659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108383200 | ||||||||
| FaxNumber: | 4108380795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2007 | ||||||||
| LastUpdateDate: | 09/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | HALPERN | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
| AuthorizedOfficialMiddleName: | RYAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3023461520 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HALPERN EYE CARE OF MARYLAND, INC. | ||||||||
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| AuthorizedOfficialCredential: | O. D. | ||||||||
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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.