Provider Demographics
NPI:1164673281
Name:CHESAPEAKE BAY OPTICIANS,INC
Entity type:Organization
Organization Name:CHESAPEAKE BAY OPTICIANS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-855-7383
Mailing Address - Street 1:3819 HARBOR RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-3110
Mailing Address - Country:US
Mailing Address - Phone:301-855-7383
Mailing Address - Fax:
Practice Address - Street 1:3819 HARBOR RD UNIT 104
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732-3110
Practice Address - Country:US
Practice Address - Phone:301-855-7383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04275834332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier