Provider Demographics
NPI:1447766001
Name:PASADENA EYE CARE, LLC
Entity Type:Organization
Organization Name:PASADENA EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-437-6000
Mailing Address - Street 1:33 MAGOTHY BEACH RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-4467
Mailing Address - Country:US
Mailing Address - Phone:410-437-6000
Mailing Address - Fax:
Practice Address - Street 1:33 MAGOTHY BEACH RD STE 104
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4467
Practice Address - Country:US
Practice Address - Phone:410-437-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty