Provider Demographics
NPI:1538208277
Name:PSM INC.
Entity type:Organization
Organization Name:PSM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:KISPERT
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-474-7712
Mailing Address - Street 1:8957 EDMONSTON RD
Mailing Address - Street 2:SUITE E & G
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1005
Mailing Address - Country:US
Mailing Address - Phone:301-474-7712
Mailing Address - Fax:301-220-0080
Practice Address - Street 1:8957 EDMONSTON RD
Practice Address - Street 2:SUITE E & G
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1005
Practice Address - Country:US
Practice Address - Phone:301-474-7712
Practice Address - Fax:301-220-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
145814Medicare PIN
DQ7425Medicare PIN