Organization
CUSTOM EYES OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRED HAVELOCK OPTN (PRES)
(410) 833-1910
Entity
Organization
Contact information
Practice address
11977 REISTERSTOWN RD, REISTERSTOWN, MD 21136-3030
(410) 833-1910
(410) 833-1911
Mailing address
11977 REISTERSTOWN RD, REISTERSTOWN, MD 21136-3030
(410) 833-1910
(410) 833-1911
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA0666
MD
Other
Enumeration date
05/09/2007
Last updated
08/22/2020
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