Provider Demographics
NPI:1114355377
Name:SEIDENBERG PROTZKO EYE ASSOCIATES
Entity Type:Organization
Organization Name:SEIDENBERG PROTZKO EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-942-9476
Mailing Address - Street 1:2023 PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2137
Mailing Address - Country:US
Mailing Address - Phone:410-939-6477
Mailing Address - Fax:410-939-6555
Practice Address - Street 1:360 E PULASKI HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6457
Practice Address - Country:US
Practice Address - Phone:410-620-3600
Practice Address - Fax:410-620-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-28
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1239332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier