Provider Demographics
NPI:1407028962
Name:GLAUCOMA CONSULTANTS OF WASHINGTON
Entity Type:Organization
Organization Name:GLAUCOMA CONSULTANTS OF WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:IMTIAZ
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-804-1234
Mailing Address - Street 1:PO BOX 651091
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-1091
Mailing Address - Country:US
Mailing Address - Phone:240-804-1234
Mailing Address - Fax:240-804-1236
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:SUITE PLAZA#7
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:240-804-1234
Practice Address - Fax:240-804-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53502207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty