Provider Demographics
NPI:1033453790
Name:GEORGE CONSTANTINOPOULOS OD AND ASSOCIATES. LLC
Entity Type:Organization
Organization Name:GEORGE CONSTANTINOPOULOS OD AND ASSOCIATES. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSTANTINOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-423-4061
Mailing Address - Street 1:6675 MARIE CURIE DR
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6457
Mailing Address - Country:US
Mailing Address - Phone:410-423-4061
Mailing Address - Fax:
Practice Address - Street 1:6675 MARIE CURIE DR
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6457
Practice Address - Country:US
Practice Address - Phone:410-423-4061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1802152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty