Provider Demographics
NPI:1598045957
Name:VISION AND CONCEPTUAL DEVELOPMENT CENTER LLC
Entity Type:Organization
Organization Name:VISION AND CONCEPTUAL DEVELOPMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZELLER MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-951-0320
Mailing Address - Street 1:4608 S CHELSEA LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3718
Mailing Address - Country:US
Mailing Address - Phone:301-951-0320
Mailing Address - Fax:301-951-0370
Practice Address - Street 1:6900 WISCONSIN AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6114
Practice Address - Country:US
Practice Address - Phone:301-951-0320
Practice Address - Fax:301-951-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1930152WP0200X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty