Provider Demographics
NPI:1912312760
Name:MARYLAND VISION INSTITUTE, LLC
Entity Type:Organization
Organization Name:MARYLAND VISION INSTITUTE, LLC
Other - Org Name:MARYLAND VISION INSTITUTE HANCOCK OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTUS
Authorized Official - Middle Name:G
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-791-0888
Mailing Address - Street 1:263 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21750-1042
Mailing Address - Country:US
Mailing Address - Phone:301-678-6993
Mailing Address - Fax:301-678-6434
Practice Address - Street 1:263 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MD
Practice Address - Zip Code:21750-1042
Practice Address - Country:US
Practice Address - Phone:301-678-6993
Practice Address - Fax:301-678-6434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPENDINGMedicare PIN