NPIMap

Organization Active NPI

Chippewa Optical LLC

  • Optometrist
  • Baltimore, MD
National Provider Identifier
1972017358
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
CHIPPEWA OPTICAL LLC
Doing business as
ActualEyes
Practice address
305 Reisterstown Rd
Baltimore, MD 21208-5313
Phone
(410) 406-7951
Fax
(443) 648-9001
NPI assigned
Nov 21, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Authorized official

Name
Dovid Pinchus BerkovitsNPI 1215441696
Title
Member
Phone
(410) 406-7951

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary
OpticianGroup: 193200000X MULTI-SPECIALTY GROUP 156FX1800X

Addresses

Primary practice location

305 Reisterstown Rd
Baltimore, MD 21208-5313

Mailing address

305 Reisterstown Rd
Pikesville, MD 21208-5313
Phone (410) 406-7951

Other practice location 1

6808 Chippewa Dr
Baltimore, MD 21209-1435
Phone (410) 406-7951

Other identifiers 1

IdentifierTypeStateIssuer
555350400MedicaidMD

Other names 1

  • ActualEyes Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1511222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1972017358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 REISTERSTOWN RD",
            "city": "PIKESVILLE",
            "state": "MD",
            "postal_code": "212085313",
            "telephone_number": "410-406-7951",
            "fax_number": "443-648-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 REISTERSTOWN RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212085313",
            "telephone_number": "410-406-7951",
            "fax_number": "443-648-9001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6808 Chippewa Dr",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212091435",
            "country_code": "US",
            "telephone_number": "410-406-7951",
            "fax_number": "443-648-9001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHIPPEWA OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-21",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "BERKOVITS",
        "authorized_official_first_name": "DOVID",
        "authorized_official_middle_name": "PINCHUS",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "410-406-7951"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "555350400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ActualEyes",
            "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 Dec 21, 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.

Verify at the official NPI Registry.