Provider Demographics
NPI:1235489030
Name:FIRST SIGHT VISION CARE LLC
Entity Type:Organization
Organization Name:FIRST SIGHT VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:NUTAPORN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKONTASUP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:443-804-1173
Mailing Address - Street 1:8315 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6687
Mailing Address - Country:US
Mailing Address - Phone:443-804-1173
Mailing Address - Fax:
Practice Address - Street 1:8160 MAPLE LAWN BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759
Practice Address - Country:US
Practice Address - Phone:443-804-1173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center