Provider Demographics
NPI:1467151696
Name:COLUMBIA EYE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:COLUMBIA EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:240-498-6768
Mailing Address - Street 1:10015 OLD COLUMBIA RD STE J135
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1741
Mailing Address - Country:US
Mailing Address - Phone:410-381-1688
Mailing Address - Fax:410-381-3855
Practice Address - Street 1:10015 OLD COLUMBIA RD STE J135
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1741
Practice Address - Country:US
Practice Address - Phone:410-381-1688
Practice Address - Fax:410-381-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD41817OtherDAVIS VISION
MDY673-0002OtherBLUE CROSS BLUE SHIELD