Provider Demographics
NPI:1417986712
Name:IVAN H GARCIA MD PC
Entity Type:Organization
Organization Name:IVAN H GARCIA MD PC
Other - Org Name:OMNI EYE SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:FOUNDING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WASLOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-281-2656
Mailing Address - Street 1:2925 LORD BALTIMORE DR.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2566
Mailing Address - Country:US
Mailing Address - Phone:410-277-3937
Mailing Address - Fax:410-281-9388
Practice Address - Street 1:2925 LORD BALTIMORE DR.
Practice Address - Street 2:SUITE 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2566
Practice Address - Country:US
Practice Address - Phone:410-277-3937
Practice Address - Fax:410-281-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
MD174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD078561000Medicaid
MD4125061000Medicaid
MDK769Medicare PIN