Provider Demographics
NPI:1437141942
Name:WAXMAN, CARL M (OD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:M
Last Name:WAXMAN
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 1:920 PROVIDENCE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2976
Mailing Address - Country:US
Mailing Address - Phone:410-486-1010
Mailing Address - Fax:443-895-4822
Practice Address - Street 1:400 N CENTER ST
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5140
Practice Address - Country:US
Practice Address - Phone:410-857-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2020-02-25
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
MDTA0764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD30925OtherMDIPA/OPTIMUM CHOICE
MD40285OtherCOLE MANAGED VIS.
MD5167502OtherAETNA
MD911041OtherBLOCK VISION
MD210357OtherNAT'L VISION ADMIN
MD8292-0001OtherBLUE CHOICE
MD940285OtherEYEMED VISION CARE
MD410048221OtherRAILROAD MEDICARE
MD974268900Medicaid
MDX812OtherBLUE CROSS/BLUE SHIELD
MDT59967Medicare UPIN