Provider Demographics
NPI:1548281686
Name:DEBROUSE OPTICIANS
Entity type:Organization
Organization Name:DEBROUSE OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:TRETTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:FNAO
Authorized Official - Phone:410-444-2500
Mailing Address - Street 1:7601 1/2 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6401
Mailing Address - Country:US
Mailing Address - Phone:410-444-2500
Mailing Address - Fax:410-444-2500
Practice Address - Street 1:7601 1/2 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-6401
Practice Address - Country:US
Practice Address - Phone:410-444-2500
Practice Address - Fax:410-444-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30249681332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0137980001Medicare ID - Type Unspecified