Provider Demographics
NPI:1720145766
Name:SEIDENBERG PROTZKO EYE ASSOCIATES
Entity Type:Organization
Organization Name:SEIDENBERG PROTZKO EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:443-643-4505
Mailing Address - Street 1:2023 PULASKI HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:HAVRE DEGRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078
Mailing Address - Country:US
Mailing Address - Phone:410-939-6477
Mailing Address - Fax:410-939-6555
Practice Address - Street 1:520 UPPER CHESAPEAKE DR
Practice Address - Street 2:SUITE 401
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4339
Practice Address - Country:US
Practice Address - Phone:443-643-4505
Practice Address - Fax:443-643-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1239332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKF61OtherCAREFIRST BLUESHIELD
MDW245OtherCAREFIRST NCA
MDKF61OtherCAREFIRST BLUESHIELD