Provider Demographics
NPI:1003853136
Name:SILVER SPRING OPHTHALMOLOGY, LLC
Entity Type:Organization
Organization Name:SILVER SPRING OPHTHALMOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-657-3022
Mailing Address - Street 1:8630 FENTON STREET
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:301-585-8880
Mailing Address - Fax:301-585-6521
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:SUITE 800
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-585-8880
Practice Address - Fax:301-585-6521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1177261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
310953Medicare ID - Type Unspecified