Provider Demographics
NPI:1033427679
Name:CHASE EYE CARE
Entity Type:Organization
Organization Name:CHASE EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GNANAKKAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-676-1010
Mailing Address - Street 1:1812 PULASKI HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-1697
Mailing Address - Country:US
Mailing Address - Phone:401-676-1010
Mailing Address - Fax:443-922-7582
Practice Address - Street 1:1812 PULASKI HWY
Practice Address - Street 2:SUITE A
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-1697
Practice Address - Country:US
Practice Address - Phone:401-676-1010
Practice Address - Fax:443-922-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD031837000Medicaid
MD131142ZAMUMedicare PIN
AZU89697Medicare UPIN