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Organization

LONGMEADOW EYECARE INCORPORATED

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID W HUNTZBERRY (PRESIDENT)
(301) 797-3030
Entity
Organization

Contact information

Practice address
1545 POTOMAC AVE, HAGERSTOWN, MD 21742-2930
(301) 797-3030
Mailing address
1545 POTOMAC AVE, HAGERSTOWN, MD 21742-2930
(301) 797-3030

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
332H00000X
Eyewear Supplier
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0736980001
MEDICARE DMERC
05
111658400
MD
01
53066701 X754LO
BLUE CROSS OF MARYLAND
MD
Enumeration date
10/05/2005
Last updated
07/26/2012
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