Provider Demographics
NPI:1356435572
Name:SELECT EYE CARE PA
Entity type:Organization
Organization Name:SELECT EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LABORWIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-821-6400
Mailing Address - Street 1:8601 LASALLE RD
Mailing Address - Street 2:108
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2005
Mailing Address - Country:US
Mailing Address - Phone:410-821-6400
Mailing Address - Fax:410-339-3846
Practice Address - Street 1:8601 LASALLE RD
Practice Address - Street 2:108
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2005
Practice Address - Country:US
Practice Address - Phone:410-821-6400
Practice Address - Fax:410-339-3846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050028207W00000X
MDD0006791207W00000X
MDTA1383152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD366302700Medicaid
DCE689000OtherBCBS CHOICE
MPLS06OtherBCBS OF MARYLAND
MD845124900Medicaid
MD026421100Medicaid
MPLS06OtherBCBS OF MARYLAND
DCE689000OtherBCBS CHOICE
MDC57425Medicare UPIN
C57425Medicare UPIN
MD884LMedicare PIN
MD845124900Medicaid