Provider Demographics
NPI:1245676915
Name:DR. DANIEL STOLTZE, LLC
Entity type:Organization
Organization Name:DR. DANIEL STOLTZE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLTZE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-879-7969
Mailing Address - Street 1:1800 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2546
Mailing Address - Country:US
Mailing Address - Phone:410-879-7969
Mailing Address - Fax:410-877-0499
Practice Address - Street 1:1800 HARFORD RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2546
Practice Address - Country:US
Practice Address - Phone:410-879-7969
Practice Address - Fax:410-877-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1296152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty