Provider Demographics
NPI:1073928800
Name:EYE RX PLLC
Entity Type:Organization
Organization Name:EYE RX PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-841-6776
Mailing Address - Street 1:4600 N PARK AVE
Mailing Address - Street 2:PLAZA NORTH
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4518
Mailing Address - Country:US
Mailing Address - Phone:301-841-6776
Mailing Address - Fax:301-215-4144
Practice Address - Street 1:4600 N PARK AVE
Practice Address - Street 2:PLAZA NORTH
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4518
Practice Address - Country:US
Practice Address - Phone:301-841-6776
Practice Address - Fax:301-215-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2244152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD375649Medicare PIN