Provider Demographics
NPI:1144411034
Name:CATONSVILLE OPTICAL
Entity Type:Organization
Organization Name:CATONSVILLE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:SENGEBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-477-1111
Mailing Address - Street 1:727 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4503
Mailing Address - Country:US
Mailing Address - Phone:410-744-1111
Mailing Address - Fax:
Practice Address - Street 1:727 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4503
Practice Address - Country:US
Practice Address - Phone:410-744-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier