Provider Demographics
NPI:1417308503
Name:CHOICE VISION CENTER LLC
Entity Type:Organization
Organization Name:CHOICE VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDETN
Authorized Official - Prefix:
Authorized Official - First Name:EJEMEARE
Authorized Official - Middle Name:
Authorized Official - Last Name:IGENE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:240-547-1432
Mailing Address - Street 1:6609 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1711
Mailing Address - Country:US
Mailing Address - Phone:240-547-1432
Mailing Address - Fax:443-458-0904
Practice Address - Street 1:975 BAY RIDGE RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-3934
Practice Address - Country:US
Practice Address - Phone:240-547-1432
Practice Address - Fax:443-458-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty