Provider Demographics
NPI:1760609820
Name:NORTH MALL OPTICS, INC.
Entity Type:Organization
Organization Name:NORTH MALL OPTICS, INC.
Other - Org Name:LENS 'N EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:SOPHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-882-2020
Mailing Address - Street 1:8818 WALTHAM WOODS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2402
Mailing Address - Country:US
Mailing Address - Phone:410-882-2020
Mailing Address - Fax:410-882-5022
Practice Address - Street 1:8818 WALTHAM WOODS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-2402
Practice Address - Country:US
Practice Address - Phone:410-882-2020
Practice Address - Fax:410-882-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2128227OtherMAMSI, OPT. CHOICE, MDIPA
MD3089589OtherAETNA
MDZ332LEOtherBCBS
MD2128227OtherALLIANCE
MDZ332LEOtherBCBS