Provider Demographics
NPI:1760796189
Name:BETHEDSA EYE CENTER CORP
Entity Type:Organization
Organization Name:BETHEDSA EYE CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUPLESSIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-493-6404
Mailing Address - Street 1:10215 FERNWOOD RD
Mailing Address - Street 2:SUITE 98
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1106
Mailing Address - Country:US
Mailing Address - Phone:301-493-6404
Mailing Address - Fax:301-493-9694
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:SUITE 98
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1106
Practice Address - Country:US
Practice Address - Phone:301-493-6404
Practice Address - Fax:301-493-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052880207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty