Provider Demographics
NPI:1700135761
Name:CATONSVILLE EYE ASSOCIATES LLC
Entity Type:Organization
Organization Name:CATONSVILLE EYE ASSOCIATES LLC
Other - Org Name:PEEPERS FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHOEBUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-788-7113
Mailing Address - Street 1:704B N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4135
Mailing Address - Country:US
Mailing Address - Phone:410-788-7113
Mailing Address - Fax:410-788-3241
Practice Address - Street 1:704B N ROLLING RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4135
Practice Address - Country:US
Practice Address - Phone:410-788-7113
Practice Address - Fax:410-788-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0599332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier