Provider Demographics
NPI:1588654289
Name:JOHNS HOPKINS UNIVERSITY
Entity Type:Organization
Organization Name:JOHNS HOPKINS UNIVERSITY
Other - Org Name:JHU - WILMER EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR PRODUCTION UNIT MGR
Authorized Official - Prefix:
Authorized Official - First Name:SHAVONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEATING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-933-6430
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:600 NORTH WOLFE STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21264-0001
Practice Address - Country:US
Practice Address - Phone:410-614-5115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNS HOPKINS UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-24
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD152W00000X, 207W00000X
207WX0009X, 207WX0107X, 207WX0108X, 207WX0109X, 207WX0110X, 207WX0120X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Multi-Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory DiseaseGroup - Multi-Specialty
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmologyGroup - Multi-Specialty
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus SpecialistGroup - Multi-Specialty
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Multi-Specialty
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCA9060OtherRRMC
MD769191200Medicaid
DC010170055Medicaid
MDKR85Medicare ID - Type Unspecified