Provider Demographics
NPI:1144403908
Name:CAMBRIDGE FAMILY EYE CARE, LLC
Entity Type:Organization
Organization Name:CAMBRIDGE FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-228-0500
Mailing Address - Street 1:401 RACE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1835
Mailing Address - Country:US
Mailing Address - Phone:410-228-0500
Mailing Address - Fax:410-228-0504
Practice Address - Street 1:401 RACE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1835
Practice Address - Country:US
Practice Address - Phone:410-228-0500
Practice Address - Fax:410-228-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD771378900Medicaid
MD6117660001Medicare NSC
MD771378900Medicaid