Provider Demographics
NPI:1588857379
Name:ALLEGANY OPTICAL LLC
Entity Type:Organization
Organization Name:ALLEGANY OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O.D. / MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITELOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-263-2389
Mailing Address - Street 1:1305 W 7TH ST
Mailing Address - Street 2:STE. 15A
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4100
Mailing Address - Country:US
Mailing Address - Phone:301-695-4855
Mailing Address - Fax:301-695-4870
Practice Address - Street 1:1305 W 7TH ST
Practice Address - Street 2:STE. 15A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4100
Practice Address - Country:US
Practice Address - Phone:301-695-4855
Practice Address - Fax:301-695-4870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10236876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1252160011Medicare NSC
MD010MMedicare PIN