Provider Demographics
NPI:1497714356
Name:MT. AIRY EYE CARE, LLC
Entity Type:Organization
Organization Name:MT. AIRY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-829-2221
Mailing Address - Street 1:1507 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5393
Mailing Address - Country:US
Mailing Address - Phone:301-829-2221
Mailing Address - Fax:301-831-4040
Practice Address - Street 1:1507 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5393
Practice Address - Country:US
Practice Address - Phone:301-829-2221
Practice Address - Fax:301-831-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDD1082OtherRAILROAD MEDICARE
MDDD1082OtherRAILROAD MEDICARE
MD=========OtherTAX ID
MD079NMedicare PIN