Provider Demographics
NPI:1225203987
Name:ROCKVILLE EYE CENTER, INC.
Entity Type:Organization
Organization Name:ROCKVILLE EYE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:PEI
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-231-5222
Mailing Address - Street 1:11125 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3142
Mailing Address - Country:US
Mailing Address - Phone:301-231-5222
Mailing Address - Fax:301-231-0551
Practice Address - Street 1:11125 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 303
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:301-231-5222
Practice Address - Fax:301-231-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416962000Medicaid
MD129681Medicare PIN