Provider Demographics
NPI:1376679100
Name:EYE CONSULTANTS OF MARYLAND PA
Entity Type:Organization
Organization Name:EYE CONSULTANTS OF MARYLAND PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:SOL
Authorized Official - Last Name:SCHOCKET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-281-2020
Mailing Address - Street 1:21 CROSSROADS DR
Mailing Address - Street 2:SUITE 425
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5441
Mailing Address - Country:US
Mailing Address - Phone:410-581-2020
Mailing Address - Fax:410-654-9264
Practice Address - Street 1:21 CROSSROADS DR
Practice Address - Street 2:SUITE 425
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5441
Practice Address - Country:US
Practice Address - Phone:410-581-2020
Practice Address - Fax:410-654-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD472741000Medicaid
MD472741000Medicaid
MD0870040001Medicare NSC