Provider Demographics
NPI:1184633257
Name:MONTGOMERY COUNTY EYE CARE LLC
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-948-2060
Mailing Address - Street 1:702 RUSSELL AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2606
Mailing Address - Country:US
Mailing Address - Phone:301-948-2060
Mailing Address - Fax:301-948-7687
Practice Address - Street 1:702 RUSSELL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2606
Practice Address - Country:US
Practice Address - Phone:301-948-2060
Practice Address - Fax:301-948-7687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94112Medicare UPIN
MD5779030001Medicare NSC
MDG01878Medicare PIN