Provider Demographics
NPI:1902821838
Name:ATCHERSON, RAY MORSE (OO)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:MORSE
Last Name:ATCHERSON
Suffix:
Gender:M
Credentials:OO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 BAY DALE DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2325
Mailing Address - Country:US
Mailing Address - Phone:410-757-1350
Mailing Address - Fax:410-757-7835
Practice Address - Street 1:1294 BAY DALE DR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2325
Practice Address - Country:US
Practice Address - Phone:410-757-1350
Practice Address - Fax:410-757-7835
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO 740152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD980078600Medicaid
MD485LMedicare ID - Type Unspecified
MD980078600Medicaid