Provider Demographics
NPI:1225158686
Name:ACCUVISION ELLICOTT CITY INC
Entity Type:Organization
Organization Name:ACCUVISION ELLICOTT CITY INC
Other - Org Name:PEARLE EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-461-2020
Mailing Address - Street 1:10050 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:SUITE F100
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3501
Mailing Address - Country:US
Mailing Address - Phone:410-461-2020
Mailing Address - Fax:410-461-2672
Practice Address - Street 1:10050 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE F100
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3501
Practice Address - Country:US
Practice Address - Phone:410-461-2020
Practice Address - Fax:410-461-2672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0888305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0827520002Medicare NSC