Provider Demographics
NPI:1881632313
Name:DOUD, PENELOPE STAMMER (OD)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:STAMMER
Last Name:DOUD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HOLIDAY CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7003
Mailing Address - Country:US
Mailing Address - Phone:410-266-0099
Mailing Address - Fax:410-266-8629
Practice Address - Street 1:130 HOLIDAY CT
Practice Address - Street 2:SUITE 109
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7003
Practice Address - Country:US
Practice Address - Phone:410-266-0099
Practice Address - Fax:410-266-8629
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1038152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3019295OtherAETNA HMO
MD5851409OtherAETNA PPO
MDTA1038OtherLICENSE
MD61045001OtherBCBS
DCF038OtherBCBS
MD313067OtherOPTIMUM CHOICE/MDIPA
DCF038OtherBCBS
MDU46672Medicare UPIN