Provider Demographics
NPI:1972825388
Name:CHANNING, EUGENE STEPHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:STEPHAN
Last Name:CHANNING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:EUGENE
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:166 BAUGHMAN'S LANE
Mailing Address - Street 2:CHANNING VISION-EYE CARE, INC.
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4083
Mailing Address - Country:US
Mailing Address - Phone:301-663-1177
Mailing Address - Fax:
Practice Address - Street 1:166 BAUGHMAN'S LANE
Practice Address - Street 2:CHANNING VISION-EYE CARE, INC.
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4083
Practice Address - Country:US
Practice Address - Phone:301-663-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO967152W00000X
VA0618000256152W00000X
DCOP593152W00000X
PAOEG001617152W00000X
NJ27OA00280800152W00000X
NY002831152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD545435-01KAN6CHOtherCAREFIRST BLUECROSS BLUESHIELD
DCF234-0001OtherCAREFIRST BLUECROSS BLUESHIELD
52-2219623OtherTRICARE NORTH
VAMC0239219OtherDRUG ENFORCEMENT ADMINISTRATION
MD545435-01KAN6CHOtherCAREFIRST BLUECROSS BLUESHIELD
52-2219623OtherTRICARE NORTH