Provider Demographics
NPI:1841593902
Name:ERIC COHEN
Entity Type:Organization
Organization Name:ERIC COHEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCHERR
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:410-944-8020
Mailing Address - Street 1:6660 SECURITY BLVD # D
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4012
Mailing Address - Country:US
Mailing Address - Phone:410-944-8020
Mailing Address - Fax:410-944-5621
Practice Address - Street 1:6660 SECURITY BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4012
Practice Address - Country:US
Practice Address - Phone:410-944-8020
Practice Address - Fax:410-944-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD801958401Medicaid
MD801958401Medicaid