Provider Demographics
NPI:1447222336
Name:FINE, NORMAN FRANKLIN (OD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:FRANKLIN
Last Name:FINE
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 1:1311 S. MAIN ST. STE 104
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771
Mailing Address - Country:US
Mailing Address - Phone:301-829-4118
Mailing Address - Fax:301-829-1302
Practice Address - Street 1:1311 S. MAIN ST. STE 104
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771
Practice Address - Country:US
Practice Address - Phone:301-829-4118
Practice Address - Fax:301-829-1302
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO599152WS0006X
MDTA0599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD801118400Medicaid
MD000X237OtherBLUE CROSS/BLUE SHIELD
DC89160002OtherBLUECROSS/BLUESHEILD
MD1031589OtherAETNA
MD271019OtherMDIPA
MD013280EI9Medicare PIN
MD281L540BMedicare PIN