Provider Demographics
NPI:1629374574
Name:DRS. VAXMONSKY & BALOGA EYE CARE
Entity Type:Organization
Organization Name:DRS. VAXMONSKY & BALOGA EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAXMONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-559-0090
Mailing Address - Street 1:3500 E WEST HWY
Mailing Address - Street 2:C/O LENSCRAFTERS
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1916
Mailing Address - Country:US
Mailing Address - Phone:301-559-0090
Mailing Address - Fax:301-559-1964
Practice Address - Street 1:3500 E WEST HWY
Practice Address - Street 2:C/O LENSCRAFTERS
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1916
Practice Address - Country:US
Practice Address - Phone:301-559-0090
Practice Address - Fax:301-559-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMDTA0999152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA064796Medicare PIN
T49137Medicare UPIN