Charles R Mund, OD.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TAO866 Issued in MD

Practice address

5701 Greenbelt Rd
Berwyn Heights, MD 20740-2257

Phone

(301) 345-2053

Fax

(301) 441-1752

NPI assigned

May 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292371200000",
    "number": "1629029012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 GREENBELT RD",
            "city": "BERWYN HEIGHTS",
            "state": "MD",
            "postal_code": "207402257",
            "telephone_number": "301-345-2053",
            "fax_number": "301-441-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 GREENBELT RD",
            "city": "BERWYN HEIGHTS",
            "state": "MD",
            "postal_code": "207402257",
            "telephone_number": "301-345-2053",
            "fax_number": "301-441-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUND",
        "first_name": "CHARLES",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "OD.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2010-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TAO866",
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "MD",
            "license": "TAO866",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091730300",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1003325",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI/ALLIANCE",
            "identifier": "271019",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "89160003",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Berwyn Heights, MD
• Providers in Berwyn Heights, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2010; 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.