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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