Provider Demographics
NPI:1952593345
Name:OPTICALCARE
Entity Type:Organization
Organization Name:OPTICALCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARTYN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:410-761-0098
Mailing Address - Street 1:300 HOSPITAL DR
Mailing Address - Street 2:SUITE 121
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-761-0078
Mailing Address - Fax:410-761-0353
Practice Address - Street 1:300 HOSPITAL DR
Practice Address - Street 2:SUITE 121
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6902
Practice Address - Country:US
Practice Address - Phone:410-761-0078
Practice Address - Fax:410-760-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD53281002OtherMD PROVIDER NUMBER
MD=========OtherEIN
MD53281002OtherMD PROVIDER NUMBER