Provider Demographics
NPI:1548286677
Name:AMEDEU, JAMES SCLUCTORE (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SCLUCTORE
Last Name:AMEDEU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2811 LORD BALTIMORE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244
Mailing Address - Country:US
Mailing Address - Phone:443-316-2101
Mailing Address - Fax:410-265-6068
Practice Address - Street 1:1100 WEST PATRICK ST
Practice Address - Street 2:UNITED OPTICAL
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703
Practice Address - Country:US
Practice Address - Phone:301-698-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMDTA0905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U75522Medicare UPIN