Provider Demographics
NPI:1255311395
Name:PARRIS-CASTORO EYE CARE CENTER, P.A.
Entity Type:Organization
Organization Name:PARRIS-CASTORO EYE CARE CENTER, P.A.
Other - Org Name:PARRIS CASTORO AMBULATORY SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-399-8451
Mailing Address - Street 1:620 BOULTON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4255
Mailing Address - Country:US
Mailing Address - Phone:410-399-8426
Mailing Address - Fax:410-399-8427
Practice Address - Street 1:620 BOULTON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4255
Practice Address - Country:US
Practice Address - Phone:410-399-8426
Practice Address - Fax:410-399-8427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1021261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD299131400Medicaid
MDZZ85Medicare PIN