Provider Demographics
NPI:1538209309
Name:CHESAPEAKE EYE CENTER, P.A.
Entity type:Organization
Organization Name:CHESAPEAKE EYE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HASELNUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-749-1191
Mailing Address - Street 1:105 PINE BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7160
Mailing Address - Country:US
Mailing Address - Phone:410-749-1191
Mailing Address - Fax:410-749-6111
Practice Address - Street 1:105 PINE BLUFF RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7160
Practice Address - Country:US
Practice Address - Phone:410-749-1191
Practice Address - Fax:410-749-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD236541300Medicaid
MD0818270001Medicare NSC
MD240LMedicare ID - Type Unspecified