Provider Demographics
NPI:1891856357
Name:DR IRWIN AZMAN & DR THOMAS AZMAN ODS PA
Entity Type:Organization
Organization Name:DR IRWIN AZMAN & DR THOMAS AZMAN ODS PA
Other - Org Name:AZMAN EYE CARE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-561-8050
Mailing Address - Street 1:2219 YORK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3140
Mailing Address - Country:US
Mailing Address - Phone:410-561-8050
Mailing Address - Fax:410-561-8055
Practice Address - Street 1:2219 YORK RD STE 101
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3140
Practice Address - Country:US
Practice Address - Phone:410-561-8050
Practice Address - Fax:410-561-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2126152W00000X
MDDA0515152W00000X
MDTA0678152W00000X
MDTA0719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty