Basic Information
| Provider Information | |||||||||
| NPI: | 1912911470 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOMKO | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2811 LORD BALTIMORE DR | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4433162101 | ||||||||
| FaxNumber: | 4102656068 | ||||||||
| Practice Location | |||||||||
| Address1: | 6630 SECURITY BLVD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102984040 | ||||||||
| FaxNumber: | 4102984167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | TA1094 | MD | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | OP668 | DC | N | Eye and Vision Services Providers | Optometrist |
No ID Information.