Provider Demographics
NPI:1417259839
Name:BETHESDA EYE SURGERY CENTER
Entity Type:Organization
Organization Name:BETHESDA EYE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUPLESSIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-493-6404
Mailing Address - Street 1:7815 ENGLISH WAY
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1966
Mailing Address - Country:US
Mailing Address - Phone:301-493-6404
Mailing Address - Fax:301-493-9694
Practice Address - Street 1:7815 ENGLISH WAY
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-493-6404
Practice Address - Fax:301-493-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPENDING261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery