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Organization Active NPI

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  • Optometrist
  • Baltimore, MD
National Provider Identifier
1295085264
Registry record updated Mar 29, 2013
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Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA2187 Issued in MD
Legal business name
VISION ICONIQUE
Practice address
6080 Falls Rd
LL1
Baltimore, MD 21209-2230
Phone
(443) 895-4528
NPI assigned
Sep 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2013

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

Authorized official

Name
Dr. Nadia Rutayisire, OD, MPH
Title
Owner/Optometrist
Phone
(443) 895-4528

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X TA2187 MD Primary

Addresses

Primary practice location

6080 Falls Rd
LL1
Baltimore, MD 21209-2230

Mailing address

6080 Falls Rd
LL1
Baltimore, MD 21209-2230
Phone (443) 895-4528

National Provider Directory

National Provider Directory

Locations

6080 Falls Rd
Ste LL1
Baltimore, MD 21209
Phone (443) 895-4528

NPI Registry JSON

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

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364515200000",
    "number": "1295085264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6080 FALLS RD",
            "address_2": "LL1",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212092230",
            "telephone_number": "443-895-4528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6080 FALLS RD",
            "address_2": "LL1",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212092230",
            "telephone_number": "443-895-4528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION ICONIQUE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-17",
        "last_updated": "2013-03-29",
        "status": "A",
        "authorized_official_last_name": "RUTAYISIRE",
        "authorized_official_first_name": "NADIA",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "443-895-4528",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD, MPH"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2013; 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.