Individual
AIDIN DEAN GOGERDCHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1029 LIGHT ST, BALTIMORE, MD 21230-4017
(410) 752-8208
(410) 752-7144
Mailing address
1029 LIGHT ST, BALTIMORE, MD 21230-4017
(410) 752-8208
(410) 752-7144
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA2312
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TA2312
STATE LICENSE
MD
Enumeration date
07/02/2012
Last updated
05/21/2013
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