Provider Demographics
NPI:1053500777
Name:MONTGOMERY EYE PHYSICIANS & SURGEONS, P.A.
Entity Type:Organization
Organization Name:MONTGOMERY EYE PHYSICIANS & SURGEONS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, OD
Authorized Official - Phone:301-881-5888
Mailing Address - Street 1:11140 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3106
Mailing Address - Country:US
Mailing Address - Phone:301-881-5888
Mailing Address - Fax:301-881-2945
Practice Address - Street 1:11140 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 450
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3106
Practice Address - Country:US
Practice Address - Phone:301-881-5888
Practice Address - Fax:301-881-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCJ9088OtherRAILROAD MEDICARE
MD253171201Medicaid
MD198635Medicare PIN