Provider Demographics
NPI:1033317532
Name:EYE ASSOCIATES
Entity Type:Organization
Organization Name:EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:MUND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-997-1800
Mailing Address - Street 1:10801 HICKORY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3869
Mailing Address - Country:US
Mailing Address - Phone:410-997-1800
Mailing Address - Fax:301-596-5070
Practice Address - Street 1:10801 HICKORY RIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3871
Practice Address - Country:US
Practice Address - Phone:410-997-1800
Practice Address - Fax:301-596-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD281LMedicare ID - Type Unspecified
MD0479910002Medicare NSC