Provider Demographics
NPI:1659350064
Name:PARRIS-CASTORO OPTICAL CENTER INC.
Entity Type:Organization
Organization Name:PARRIS-CASTORO OPTICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-399-8451
Mailing Address - Street 1:620 BOULTON ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4255
Mailing Address - Country:US
Mailing Address - Phone:410-893-1855
Mailing Address - Fax:410-893-9796
Practice Address - Street 1:620 BOULTON ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4255
Practice Address - Country:US
Practice Address - Phone:410-893-1855
Practice Address - Fax:410-893-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12293235332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
XY82OtherBLUE SHIELD PIN NUMBER
MD4178620001Medicare NSC