Provider Demographics
NPI:1013047125
Name:HARBOR EYES OPTICAL INC
Entity Type:Organization
Organization Name:HARBOR EYES OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GENEAVEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANK
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:410-354-6401
Mailing Address - Street 1:3001 S HANOVER ST
Mailing Address - Street 2:GRUEHN BUILDING SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-1233
Mailing Address - Country:US
Mailing Address - Phone:410-354-6401
Mailing Address - Fax:410-354-6401
Practice Address - Street 1:3001 S HANOVER ST
Practice Address - Street 2:GRUEHN BUILDING SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1233
Practice Address - Country:US
Practice Address - Phone:410-354-6401
Practice Address - Fax:410-354-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30250532332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
579011OtherADVANTICA
MDX420HAOtherBCBS
MDX420HAOtherBCBS