Provider Demographics
NPI:1174511885
Name:SAUBLE, EDWARD E JR (OD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:E
Last Name:SAUBLE
Suffix:JR
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 1:6 ANTRIM ST
Mailing Address - Street 2:
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787-2237
Mailing Address - Country:US
Mailing Address - Phone:410-751-1160
Mailing Address - Fax:410-756-2530
Practice Address - Street 1:6 ANTRIM ST
Practice Address - Street 2:
Practice Address - City:TANEYTOWN
Practice Address - State:MD
Practice Address - Zip Code:21787-2237
Practice Address - Country:US
Practice Address - Phone:410-756-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD111658400Medicaid
MD351618100Medicaid
MDX653EEOtherCAREFIRST
MD402409-02OtherCAREFIRST
MDLX71LOOtherCAREFIRST
MD111658400Medicaid
MDX653EEOtherCAREFIRST