NPI |
1538208277 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
PSM INC. |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Other Organization Name |
PROFESSIONAL EYE CARE CENTER |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
3 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
8957 EDMONSTON RD |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider Second Line Business Practice Location Address |
SUITE E & G |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Provider Business Practice Location Address City Name |
GREENBELT |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Provider Business Practice Location Address State Name |
MD |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
207701005 |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
3014747712 |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
3012200080 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
2/6/2007 |
The fax number associated with the location
address of the provider being identified. |
Last Update Date |
8/25/2011 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
KING |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
CHRISTINE |
The first name of the authorized official. |
Authorized Official Middle Name |
KISPERT |
The middle name of the authorized official. |
Authorized Official Title or Position |
PRESIDENT |
The title or position of the authorized official. |
Authorized Official Telephone Number |
3014747712 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
152W00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
DR. |
|
Authorized Official Credential Text |
O.D. |
|
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
|