Provider Demographics
NPI:1760420418
Name:NUNEZ-IMHOLTZ, MARIA BERNADETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:BERNADETTE
Last Name:NUNEZ-IMHOLTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:312 RIVERMONT DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2849
Mailing Address - Country:US
Mailing Address - Phone:301-655-1661
Mailing Address - Fax:
Practice Address - Street 1:2955 CRAIN HWY STE A&B
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2810
Practice Address - Country:US
Practice Address - Phone:301-645-3600
Practice Address - Fax:301-870-9415
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1917152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist