Provider Demographics
NPI:1619093762
Name:EYE CARE ASSOCIATES OF MD, INC
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES OF MD, INC
Other - Org Name:CROFTON OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:STATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ABO MBA
Authorized Official - Phone:410-721-5533
Mailing Address - Street 1:1680 VILLAGE GRN
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2014
Mailing Address - Country:US
Mailing Address - Phone:410-721-5533
Mailing Address - Fax:
Practice Address - Street 1:1680 VILLAGE GRN
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2014
Practice Address - Country:US
Practice Address - Phone:410-721-5533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty