Organization
PENN OPTICAL CO. LTD
Active
Other names
Penn Optical Vision Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD BRADLEY FUSS O.D. (PRESIDENT)
(410) 488-6800
Entity
Organization
Contact information
Practice address
5006 SINCLAIR LN, BALTIMORE, MD 21206-5936
(410) 488-6800
(410) 488-4270
Mailing address
5006 SINCLAIR LN, BALTIMORE, MD 21206-5936
(410) 488-6800
(410) 488-4270
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
MD
152WC0802X
Corneal and Contact Management Optometrist
—
MD
152WP0200X
Pediatric Optometrist
—
MD
152WS0006X
Sports Vision Optometrist
—
MD
152WV0400X
Vision Therapy Optometrist
—
MD
152WX0102X
Occupational Vision Optometrist
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050678800
—
MD
05
—
050698200
—
MD
05
—
265668000
—
MD
05
—
281428500
—
MD
05
—
687720600
—
MD
05
—
754302600
—
MD
05
—
789538100
—
MD
05
—
792848300
—
MD
Enumeration date
05/17/2007
Last updated
05/12/2008
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