Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TA 2355 | MD |
NPI | 1013357532 |
---|---|
Provider Name | Dr. Samantha Renee House |
First Address | Towson, MD 21286-2976 |
Second Address | Owings Mills, MD 21117-3617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2013 |
Last Update Date | 08/05/2020 |