Provider Demographics
NPI:1578319638
Name:CHESAPEAKE EYE CARE & LASER CENTER LLC
Entity type:Organization
Organization Name:CHESAPEAKE EYE CARE & LASER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:EMINIZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-571-8733
Mailing Address - Street 1:PO BOX 392908
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9900
Mailing Address - Country:US
Mailing Address - Phone:410-571-8733
Mailing Address - Fax:
Practice Address - Street 1:11637 TERRACE DR STE 103
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3707
Practice Address - Country:US
Practice Address - Phone:410-571-8733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty