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Organization

LONGMEADOW OPTICAL, LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAWN R. GILL O.D. (OWNER)
(301) 662-8866
Entity
Organization

Contact information

Practice address
7420 HAYWARD RD STE 202, FREDERICK, MD 21702-2509
(301) 662-8866
(301) 293-6133
Mailing address
7420 HAYWARD RD STE 202, FREDERICK, MD 21702-2509
(301) 662-8866
(301) 293-6133

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
TA0646
MD
152W00000X
Optometrist
TA1338
MD
332H00000X
Eyewear Supplier
Primary
10199942
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
B012
BCBS FEP
01
DD3301
RAILROAD MEDICARE
MD
01
LR80LO
BLUE CROSS BLUE SHIELD
Enumeration date
02/27/2007
Last updated
03/21/2012
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