Provider Demographics
NPI:1639507031
Name:T.D.ANNAPOLIS, INC
Entity Type:Organization
Organization Name:T.D.ANNAPOLIS, INC
Other - Org Name:THOMPSON VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYBOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-982-4200
Mailing Address - Street 1:5900 GREENBELT RD
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1010
Mailing Address - Country:US
Mailing Address - Phone:301-982-4200
Mailing Address - Fax:301-441-1093
Practice Address - Street 1:5900 GREENBELT RD
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1010
Practice Address - Country:US
Practice Address - Phone:301-982-4200
Practice Address - Fax:301-441-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD345125YZ11Medicare PIN