Provider Demographics
NPI:1881792190
Name:HALPERN EYE CARE OF MARYLAND, INC.
Entity type:Organization
Organization Name:HALPERN EYE CARE OF MARYLAND, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:HALPERN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-939-2200
Mailing Address - Street 1:920 REVOLUTION ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3718
Mailing Address - Country:US
Mailing Address - Phone:410-939-2200
Mailing Address - Fax:410-939-5980
Practice Address - Street 1:920 REVOLUTION ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3718
Practice Address - Country:US
Practice Address - Phone:410-939-2200
Practice Address - Fax:410-939-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD800748900Medicaid
C30938OtherMEDICARE RAILROAD
C30938OtherMEDICARE RAILROAD
MD0320300001Medicare NSC
MD270230Medicare PIN