Provider Demographics
NPI:1902837149
Name:LADAS EYE GROUP PA
Entity Type:Organization
Organization Name:LADAS EYE GROUP PA
Other - Org Name:MARYLAND EYE CONSULTANTS AND SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:LADAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:301-681-6600
Mailing Address - Street 1:21533 DAVIS MILL RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4419
Mailing Address - Country:US
Mailing Address - Phone:301-928-1448
Mailing Address - Fax:
Practice Address - Street 1:2101 MEDICAL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4053
Practice Address - Country:US
Practice Address - Phone:301-681-6600
Practice Address - Fax:301-681-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1228OtherBLUE CROSS/BLUE SHIELD
DCCE7760OtherRAILROAD MEDICARE
DCLA141499Medicare ID - Type Unspecified