Provider Demographics
NPI:1205827003
Name:BOMSE, MEREDITH LYNN (OD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LYNN
Last Name:BOMSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5049
Mailing Address - Country:US
Mailing Address - Phone:410-744-0400
Mailing Address - Fax:410-719-6909
Practice Address - Street 1:1011 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5049
Practice Address - Country:US
Practice Address - Phone:410-744-0400
Practice Address - Fax:410-719-6909
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU81495Medicare UPIN
910LMedicare ID - Type Unspecified