Provider Demographics
NPI:1790999266
Name:BETHESDA VISION CARE LLC
Entity Type:Organization
Organization Name:BETHESDA VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BERENHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-656-0775
Mailing Address - Street 1:4300 E WEST HWY
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4433
Mailing Address - Country:US
Mailing Address - Phone:301-656-0775
Mailing Address - Fax:301-656-5164
Practice Address - Street 1:4300 E WEST HWY
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4433
Practice Address - Country:US
Practice Address - Phone:301-656-0775
Practice Address - Fax:301-656-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0907152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU51155Medicare UPIN
DC148660ZC8SMedicare PIN
MDU96459Medicare UPIN