Provider Demographics
NPI:1225733181
Name:ANGEL EYE MEDICAL LLC
Entity Type:Organization
Organization Name:ANGEL EYE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENDERLATE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTHUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-525-7803
Mailing Address - Street 1:9101 CHERRY LN STE 111
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1150
Mailing Address - Country:US
Mailing Address - Phone:443-525-7803
Mailing Address - Fax:
Practice Address - Street 1:1738 ELTON RD STE 316
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1725
Practice Address - Country:US
Practice Address - Phone:443-525-7803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty