Organization
STEPHEN POLAKOFF
Active
Other names
VISION SOURCE OF LINTHICUM, VISION SOURCE OF LINTHICUM
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTY KLEIN (OM)
(410) 859-3111
Entity
Organization
Contact information
Practice address
413 S CAMP MEADE RD, LINTHICUM, MD 21090-2701
(410) 859-3111
Mailing address
413 S CAMP MEADE RD, LINTHICUM, MD 21090-2701
(410) 859-3111
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA0668
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8019088
—
MD
Enumeration date
08/07/2017
Last updated
07/21/2022
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