Provider Demographics
NPI:1770616294
Name:TD-ANNAPOLIS INC
Entity type:Organization
Organization Name:TD-ANNAPOLIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-982-4200
Mailing Address - Street 1:5900 GREENBELT RD
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1010
Mailing Address - Country:US
Mailing Address - Phone:301-982-4200
Mailing Address - Fax:301-441-1093
Practice Address - Street 1:2331A FOREST DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3833
Practice Address - Country:US
Practice Address - Phone:410-224-8852
Practice Address - Fax:410-224-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty