Provider Demographics
NPI:1376689794
Name:CONSTANTINOPOULOS, GEORGE (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:CONSTANTINOPOULOS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 AUGUST DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4613
Mailing Address - Country:US
Mailing Address - Phone:443-482-3816
Mailing Address - Fax:410-379-3125
Practice Address - Street 1:7077 ARUNDEL MILLS CIR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1387
Practice Address - Country:US
Practice Address - Phone:410-379-3101
Practice Address - Fax:410-379-3125
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1802152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist