Provider Demographics
NPI:1003875238
Name:EYE TEL IMAGING LLC
Entity Type:Organization
Organization Name:EYE TEL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-483-6167
Mailing Address - Street 1:9130 GUILFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2581
Mailing Address - Country:US
Mailing Address - Phone:301-483-6167
Mailing Address - Fax:301-483-6168
Practice Address - Street 1:9130 GUILFORD ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2581
Practice Address - Country:US
Practice Address - Phone:301-483-6167
Practice Address - Fax:301-483-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
977LMedicare ID - Type Unspecified