Provider Demographics
NPI:1003024795
Name:CHANNING VISION EYE CARE INC
Entity Type:Organization
Organization Name:CHANNING VISION EYE CARE INC
Other - Org Name:DR EUGENE S CHANNING PRACTICE OF OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:STEPHAN
Authorized Official - Last Name:CHANNING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-663-1177
Mailing Address - Street 1:166 BAUGHMANS LANE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4083
Mailing Address - Country:US
Mailing Address - Phone:301-663-1177
Mailing Address - Fax:
Practice Address - Street 1:166 BAUGHMANS LANE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4083
Practice Address - Country:US
Practice Address - Phone:301-663-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0967152W00000X
DCOP593152W00000X
PAOEG001617152W00000X
VA0618000256152W00000X
NY002831152W00000X
NJ152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KANGCHOtherCAREFIRST BC BS
KANGCHOtherCAREFIRST BC BS
=========OtherTRICARE
U64294Medicare UPIN