Provider Demographics
NPI:1821008467
Name:OPTICAL CENTER INC
Entity Type:Organization
Organization Name:OPTICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-484-8700
Mailing Address - Street 1:1100 REISTERSTOWN ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-484-8700
Mailing Address - Fax:410-484-8015
Practice Address - Street 1:1100 REISTERSTOWN ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-484-8700
Practice Address - Fax:410-484-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0710470001Medicare ID - Type Unspecified