Provider Demographics
NPI:1861692733
Name:EYECARE ASSOCIATES,INC.
Entity type:Organization
Organization Name:EYECARE ASSOCIATES,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:STATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:410-601-9991
Mailing Address - Street 1:2411 W BELVEDERE AVE
Mailing Address - Street 2:SINAI MEDICAL OFFICE BUILDING #105
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5271
Mailing Address - Country:US
Mailing Address - Phone:410-601-9991
Mailing Address - Fax:410-601-9992
Practice Address - Street 1:2411 W BELVEDERE AVE
Practice Address - Street 2:SINAI MEDICAL OFFICE BUILDING #105
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5271
Practice Address - Country:US
Practice Address - Phone:410-601-9991
Practice Address - Fax:410-601-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3766332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1183510001Medicare NSC