Provider Demographics
NPI:1558437590
Name:AZMAN, IRWIN (OD)
Entity Type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:
Last Name:AZMAN
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 1:2219 YORK RD 100
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3140
Mailing Address - Country:US
Mailing Address - Phone:410-561-6071
Mailing Address - Fax:410-415-1691
Practice Address - Street 1:2219 YORK RD 100
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3140
Practice Address - Country:US
Practice Address - Phone:410-561-6071
Practice Address - Fax:410-415-1691
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD719152W00000X
MDTA0719152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDX031Medicare ID - Type Unspecified