Provider Demographics
NPI:1417080854
Name:MEDICAL EYE CENTER PA
Entity Type:Organization
Organization Name:MEDICAL EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-774-2750
Mailing Address - Street 1:3402 OLANDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1384
Mailing Address - Country:US
Mailing Address - Phone:301-774-2750
Mailing Address - Fax:301-774-2756
Practice Address - Street 1:3402 OLANDWOOD CT
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1384
Practice Address - Country:US
Practice Address - Phone:301-774-2750
Practice Address - Fax:301-774-2756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2011-05-16
Deactivation Date:2007-11-09
Deactivation Code:
Reactivation Date:2008-03-05
Provider Licenses
StateLicense IDTaxonomies
DC207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC410155Medicare PIN