Provider Demographics
NPI:1689761801
Name:GMS MEDICAL EYE CENTER, LLC
Entity Type:Organization
Organization Name:GMS MEDICAL EYE CENTER, LLC
Other - Org Name:THE MEDICAL EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAGAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-528-4500
Mailing Address - Street 1:420 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2888
Mailing Address - Country:US
Mailing Address - Phone:304-725-2121
Mailing Address - Fax:
Practice Address - Street 1:19719 EXECUTIVE PARK CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2639
Practice Address - Country:US
Practice Address - Phone:301-528-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-08
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21033207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02476G01Medicare PIN
MDG02476Medicare PIN
WV4099782Medicare PIN
H39643Medicare UPIN
WV9340831Medicare PIN