Provider Demographics
NPI:1114195732
Name:NEW AGE OPTICIANS
Entity Type:Organization
Organization Name:NEW AGE OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ODELL
Authorized Official - Middle Name:ARTTO
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:443-797-7754
Mailing Address - Street 1:821 N EUTAW ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4648
Mailing Address - Country:US
Mailing Address - Phone:443-797-7754
Mailing Address - Fax:410-225-8397
Practice Address - Street 1:821 N EUTAW ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4648
Practice Address - Country:US
Practice Address - Phone:443-797-7754
Practice Address - Fax:410-225-8397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-16
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier