Provider Demographics
NPI:1689096497
Name:DAVID Z. EPHRAIM, O.D., LLC
Entity Type:Organization
Organization Name:DAVID Z. EPHRAIM, O.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER LLC
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ZACHARY
Authorized Official - Last Name:EPHRAIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-942-2221
Mailing Address - Street 1:10518 CONNECTICUT AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2469
Mailing Address - Country:US
Mailing Address - Phone:301-942-2221
Mailing Address - Fax:301-942-6338
Practice Address - Street 1:10518 CONNECTICUT AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2469
Practice Address - Country:US
Practice Address - Phone:301-942-2221
Practice Address - Fax:301-942-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2283152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty