Stephen Polakoff

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA0668 Issued in MD

Legal business name

STEPHEN POLAKOFF

Practice address

413 S Camp Meade Rd
Linthicum, MD 21090-2701

Phone

(410) 859-3111

NPI assigned

Aug 7, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christy Klein

Title

Om

Phone

(410) 859-3111

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• VISION SOURCE OF LINTHICUM Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephen Mark Polakoff, O.D.

  • Optometrist
  • Linthicum, MD
  • NPI 1265420921
  NPD

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

{
    "created_epoch": "1502064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1710402219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 S CAMP MEADE RD",
            "city": "LINTHICUM",
            "state": "MD",
            "postal_code": "210902701",
            "telephone_number": "410-859-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 S CAMP MEADE RD",
            "city": "LINTHICUM",
            "state": "MD",
            "postal_code": "210902701",
            "telephone_number": "410-859-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN POLAKOFF",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-07",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KLEIN",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "OM",
        "authorized_official_telephone_number": "410-859-3111"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA0668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8019088",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VISION SOURCE OF LINTHICUM",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VISION SOURCE OF LINTHICUM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.