Provider Demographics
NPI:1942425905
Name:OPHTHALMIC PHOTOGRAPHY INC
Entity Type:Organization
Organization Name:OPHTHALMIC PHOTOGRAPHY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-328-5934
Mailing Address - Street 1:3131 ENCLAVE CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3337
Mailing Address - Country:US
Mailing Address - Phone:410-328-6533
Mailing Address - Fax:410-328-1178
Practice Address - Street 1:3131 ENCLAVE CT
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3337
Practice Address - Country:US
Practice Address - Phone:410-328-6533
Practice Address - Fax:410-328-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD780271400Medicaid
MD5433Medicare PIN
MDS109V877Medicare PIN
MDS109Medicare ID - Type Unspecified