Provider Demographics
NPI:1134262249
Name:EYECARE MANAGEMENT, INC.
Entity type:Organization
Organization Name:EYECARE MANAGEMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-539-5520
Mailing Address - Street 1:67 W TIMONIUM RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3107
Mailing Address - Country:US
Mailing Address - Phone:410-561-8078
Mailing Address - Fax:410-561-8449
Practice Address - Street 1:67 W TIMONIUM RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3107
Practice Address - Country:US
Practice Address - Phone:410-561-8078
Practice Address - Fax:410-561-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3432710001Medicare NSC