Provider Demographics
NPI:1548773278
Name:MOBILE EYE CARE OF MARYLAND
Entity Type:Organization
Organization Name:MOBILE EYE CARE OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:443-204-3939
Mailing Address - Street 1:7410 WINDSTREAM CIR APT 301
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-5060
Mailing Address - Country:US
Mailing Address - Phone:443-204-3939
Mailing Address - Fax:888-609-9664
Practice Address - Street 1:7410 WINDSTREAM CIR APT 301
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-5060
Practice Address - Country:US
Practice Address - Phone:443-204-3939
Practice Address - Fax:888-609-9664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID
MD=========Medicaid