Provider Demographics
NPI:1689697021
Name:OPPENHEIMER, AHAVA (OD)
Entity Type:Individual
Prefix:
First Name:AHAVA
Middle Name:
Last Name:OPPENHEIMER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7028 WALLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1711
Mailing Address - Country:US
Mailing Address - Phone:917-406-8264
Mailing Address - Fax:
Practice Address - Street 1:12621 WATERSPOUT CT
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1028
Practice Address - Country:US
Practice Address - Phone:443-621-0756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006666152W00000X
MDDA2274152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02443158Medicaid
MDP00987185OtherRAILROAD MEDICARE
NY02443158Medicaid
MDP00987185OtherRAILROAD MEDICARE
C305BK9821Medicare UPIN
DC226929YFD3Medicare PIN