NPIMap

Organization Active NPI

Penn Optical Co. LTD

  • Optometrist
  • Baltimore, MD
National Provider Identifier
1902013824
Registry record updated May 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PENN OPTICAL CO. LTD
Practice address
5006 Sinclair LN
Baltimore, MD 21206-5936
Phone
(410) 488-6800
Fax
(410) 488-4270
NPI assigned
May 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2008

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

Authorized official

Name
Dr. Richard Bradley Fuss, O.D.
Title
President
Phone
(410) 488-6800

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X MD Primary
Corneal and Contact Management OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WC0802X MD
Pediatric OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WP0200X MD
Sports Vision OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WS0006X MD
Vision Therapy OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WV0400X MD
Occupational Vision OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WX0102X MD

Addresses

Primary practice location

5006 Sinclair LN
Baltimore, MD 21206-5936

Mailing address

5006 Sinclair LN
Baltimore, MD 21206-5936
Phone (410) 488-6800

Other identifiers 8

IdentifierTypeStateIssuer
792848300MedicaidMD
687720600MedicaidMD
754302600MedicaidMD
281428500MedicaidMD
050678800MedicaidMD
789538100MedicaidMD
050698200MedicaidMD
265668000MedicaidMD

Other names 1

  • Penn Optical Vision Care Doing business as

National Provider Directory

National Provider Directory

Locations

1537 Merritt Blvd
Baltimore, MD 21222
Phone (410) 282-1929

2122 E Monument St
Baltimore, MD 21205
Phone (410) 327-7070

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210550400000",
    "number": "1902013824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5006 SINCLAIR LN",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212065936",
            "telephone_number": "410-488-6800",
            "fax_number": "410-488-4270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5006 SINCLAIR LN",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212065936",
            "telephone_number": "410-488-6800",
            "fax_number": "410-488-4270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENN OPTICAL CO. LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2008-05-12",
        "status": "A",
        "authorized_official_last_name": "FUSS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "BRADLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-488-6800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MD",
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Occupational Vision",
            "state": "MD",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "792848300",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "687720600",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "754302600",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "281428500",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "050678800",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "789538100",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "050698200",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265668000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Penn Optical Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 12, 2008; 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.