Active NPI
Elizabeth Vujanovich
- Optometrist
- Havre de Grace, MD
National Provider Identifier
1275290306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2839
- Practice address
- 920 Revolution St
Havre de Grace, MD 21078-3748 - Phone
- (410) 939-2200
- NPI assigned
- Nov 23, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2839 | MD | Primary |
Addresses
Primary practice location
920 Revolution St
Havre de Grace, MD 21078-3748
Mailing address
1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2839 | MD | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639612800000",
"number": "1275290306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1950 OLD GALLOWS RD STE 520",
"city": "VIENNA",
"state": "VA",
"postal_code": "221823970",
"telephone_number": "703-847-8899",
"fax_number": "571-223-6780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 REVOLUTION ST",
"city": "HAVRE DE GRACE",
"state": "MD",
"postal_code": "210783748",
"telephone_number": "410-939-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VUJANOVICH",
"first_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-23",
"last_updated": "2021-12-16",
"certification_date": "2021-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MD",
"license": "2839",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Havre de Grace, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.