Basic Information
| Provider Information | |||||||||
| NPI: | 1477651248 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TILLES | ||||||||
| FirstName: | BARRY | ||||||||
| MiddleName: | FRANK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 580-E RITCHIE HWY | ||||||||
| Address2: | |||||||||
| City: | SEVERNA PARK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105447417 | ||||||||
| FaxNumber: | 4105444408 | ||||||||
| Practice Location | |||||||||
| Address1: | 580-E RITCHIE HWY | ||||||||
| Address2: | |||||||||
| City: | SEVERNA PARK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105447417 | ||||||||
| FaxNumber: | 4105444408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 01/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TAO737 | MD | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.