Provider Demographics
NPI:1609188341
Name:VISIONARY EYECARE PROFESSIONALS
Entity Type:Organization
Organization Name:VISIONARY EYECARE PROFESSIONALS
Other - Org Name:V.EYE.P. EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:GERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-874-5777
Mailing Address - Street 1:3540 SUGARLOAF PKWY
Mailing Address - Street 2:UNIT D-04
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7912
Mailing Address - Country:US
Mailing Address - Phone:301-874-5777
Mailing Address - Fax:301-874-0497
Practice Address - Street 1:3540 SUGARLOAF PKWY
Practice Address - Street 2:UNIT D-04
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7912
Practice Address - Country:US
Practice Address - Phone:301-874-5777
Practice Address - Fax:301-874-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1970152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty