South Baltimore Eye Associtate Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA0876 Issued in MD

Legal business name

SOUTH BALTIMORE EYE ASSOCITATE INC.

Doing business as

Federal Hill Eye Care

Practice address

1029 Light St
Baltimore, MD 21230-4017

Phone

(410) 752-8208

Fax

(410) 752-7144

NPI assigned

Dec 14, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Calvert Ross Bregel Jr., O.D.

Title

Owner

Phone

(410) 752-8208

Specialties & licenses 1

Addresses

Other identifiers 9

Other names 1

• Federal Hill Eye Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305590400000",
    "number": "1003978180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029 LIGHT ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212304017",
            "telephone_number": "410-752-8208",
            "fax_number": "410-752-7144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 LIGHT ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212304017",
            "telephone_number": "410-752-8208",
            "fax_number": "410-752-7144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BALTIMORE EYE ASSOCITATE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2011-05-17",
        "status": "A",
        "authorized_official_last_name": "BREGEL",
        "authorized_official_first_name": "CALVERT",
        "authorized_official_middle_name": "ROSS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-752-8208",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA0876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "07883",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME",
            "identifier": "1084940001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI OPT CHOICE",
            "identifier": "50383",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "52142903",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLOCK",
            "identifier": "90492",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS",
            "identifier": "50349",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NVA",
            "identifier": "210070",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BALTIMORE CITY VISION",
            "identifier": "331",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "AS12101560001",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Federal Hill Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeffrey H Souryal, MD
• Fotis Gregory Souslian, M.D.
• South Baltimore C.a.P.
• South Baltimore C.a.P. Inc.
• South Baltimore C.a.P. Inc.
• South Baltinore C.a.P. Inc.
• Nikkita F Southall, M.D.
• Southeast Nursing & Rehabilitation Center
• Vickie Souther, LCSW-C
• Rachel Tarbert Southward, CRNP-F, FNP-BC,FNP-C

• Optometrist in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.