Provider Demographics
NPI:1942440789
Name:IVAN H GARCIA MD PC
Entity Type:Organization
Organization Name:IVAN H GARCIA MD PC
Other - Org Name:OMNI EYE SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:FOUNDING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WASLOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-277-3937
Mailing Address - Street 1:2925 LORD BALTIMORE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2634
Mailing Address - Country:US
Mailing Address - Phone:410-277-3937
Mailing Address - Fax:410-281-9388
Practice Address - Street 1:2925 LORD BALTIMORE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2634
Practice Address - Country:US
Practice Address - Phone:410-277-3937
Practice Address - Fax:410-281-9388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IVAN H GARCIA MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDTA2095OtherLICENSE
MDTA0943OtherLICENSE
MDTA1633OtherLICENSE
MDTA1850OtherLICENSE
MD412506100Medicaid