Provider Demographics
NPI:1437333853
Name:BARRY M. LEBOWITZ, O.D. , M.P.H. , LLC
Entity Type:Organization
Organization Name:BARRY M. LEBOWITZ, O.D. , M.P.H. , LLC
Other - Org Name:POTOMAC EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:240-683-6222
Mailing Address - Street 1:12129 DARNESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2205
Mailing Address - Country:US
Mailing Address - Phone:240-683-6222
Mailing Address - Fax:240-683-6223
Practice Address - Street 1:12129 DARNESTOWN RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2205
Practice Address - Country:US
Practice Address - Phone:240-683-6222
Practice Address - Fax:240-683-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1358152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00879OtherMEDICARE GROUP #