Provider Demographics
NPI:1609059716
Name:TOWSON OPTICAL LLC
Entity Type:Organization
Organization Name:TOWSON OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:AMERNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-296-0624
Mailing Address - Street 1:7505 OSLER DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7738
Mailing Address - Country:US
Mailing Address - Phone:410-296-0624
Mailing Address - Fax:410-337-2570
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7738
Practice Address - Country:US
Practice Address - Phone:410-296-0624
Practice Address - Fax:410-337-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03224581332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5445580001Medicare NSC