Provider Demographics
NPI:1407106669
Name:EYEDROP
Entity Type:Organization
Organization Name:EYEDROP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GM
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:AARONS
Authorized Official - Suffix:
Authorized Official - Credentials:LO
Authorized Official - Phone:202-678-2020
Mailing Address - Street 1:2220 MARTIN LUTHER KING JR AVE
Mailing Address - Street 2:WASHINGTON
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020
Mailing Address - Country:US
Mailing Address - Phone:202-678-2020
Mailing Address - Fax:
Practice Address - Street 1:2220 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5734
Practice Address - Country:US
Practice Address - Phone:202-678-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC400312001219302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC043343300Medicaid