Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618-000230 | VA |
NPI | 1013098748 |
---|---|
Provider Name | Russell B. Pearlman |
First Address | Baltimore, MD 21297-1334 |
Second Address | Sterling, VA 20166-6580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 04/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150040000 | (05) | WV |
3461106-01 | (05) | MD |
3461106-02 | (05) | MD |
U01912 | (02) | VA |