Organization
LOOKING GLASS OPTICAL CONTACTS AND EYEGLASSES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD MARC TELES ABOC (PRESIDENT OWNER)
(410) 768-0202
Entity
Organization
Contact information
Practice address
8028 RITCHIE HWY, SUITE 124, PASADENA, MD 21122-1075
(410) 768-0202
(410) 768-1330
Mailing address
8028 RITCHIE HWY, SUITE 124, PASADENA, MD 21122-1075
(410) 768-0202
(410) 768-1330
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA0974
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
603673
AETNA
MD
01
—
KEN4LO
CAREFIRST OF MARYLAND
MD
01
—
T1680001
CAREFIRST OF DC
MD
Enumeration date
01/05/2007
Last updated
08/22/2020
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