Provider Demographics
NPI:1114909348
Name:STOLTZE, DANIEL ALBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALBERT
Last Name:STOLTZE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HARFORD RD
Mailing Address - Street 2:STE 1
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2546
Mailing Address - Country:US
Mailing Address - Phone:410-877-9000
Mailing Address - Fax:410-885-6558
Practice Address - Street 1:1800 HARFORD RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2503
Practice Address - Country:US
Practice Address - Phone:410-879-7969
Practice Address - Fax:410-877-0499
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1296152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU78189Medicare UPIN