Provider Demographics
NPI:1417944299
Name:LONGMEADOW EYECARE INCORPORATED
Entity Type:Organization
Organization Name:LONGMEADOW EYECARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:HUNTZBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-797-3030
Mailing Address - Street 1:1545 POTOMAC AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2930
Mailing Address - Country:US
Mailing Address - Phone:301-797-3030
Mailing Address - Fax:
Practice Address - Street 1:1545 POTOMAC AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2930
Practice Address - Country:US
Practice Address - Phone:301-797-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0736980001OtherMEDICARE DMERC
MD53066701 X754LOOtherBLUE CROSS OF MARYLAND
MD111658400Medicaid
211LMedicare PIN
MD0736980001Medicare NSC