Provider Demographics
NPI:1700835535
Name:CHILDRENS EYE CARE LLC
Entity Type:Organization
Organization Name:CHILDRENS EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAELTERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-744-0400
Mailing Address - Street 1:1011 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5049
Mailing Address - Country:US
Mailing Address - Phone:410-744-0400
Mailing Address - Fax:410-719-6909
Practice Address - Street 1:1011 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5049
Practice Address - Country:US
Practice Address - Phone:410-744-0400
Practice Address - Fax:410-719-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM32117207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD910LMedicare ID - Type Unspecified
MDB70164Medicare UPIN