Provider Demographics
NPI:1225428865
Name:DIABETIC EYE & MACULAR DISEASE SPECIALISTS LLC
Entity Type:Organization
Organization Name:DIABETIC EYE & MACULAR DISEASE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHURA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:202-506-3479
Mailing Address - Street 1:1160 VARNUM ST NE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-399-1616
Mailing Address - Fax:866-265-5635
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:SUITE 208
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-399-1616
Practice Address - Fax:866-265-5635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty