Provider Demographics
NPI:1174641229
Name:CHERNOV OPTICAL VISION
Entity Type:Organization
Organization Name:CHERNOV OPTICAL VISION
Other - Org Name:EYE TO EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-252-5850
Mailing Address - Street 1:1819 YORK RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5119
Mailing Address - Country:US
Mailing Address - Phone:410-252-5850
Mailing Address - Fax:410-560-2165
Practice Address - Street 1:1819 YORK RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5119
Practice Address - Country:US
Practice Address - Phone:410-252-5850
Practice Address - Fax:410-560-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherTIN