Provider Demographics
NPI:1043583156
Name:TRY STATE EYE LLC
Entity Type:Organization
Organization Name:TRY STATE EYE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-398-7077
Mailing Address - Street 1:117 LANDING LN
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5255
Mailing Address - Country:US
Mailing Address - Phone:410-398-7077
Mailing Address - Fax:410-392-9577
Practice Address - Street 1:117 LANDING LN
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5255
Practice Address - Country:US
Practice Address - Phone:410-398-7077
Practice Address - Fax:410-392-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty