Provider Demographics
NPI:1013260025
Name:MARYLAND VISION CENTER, P.A.
Entity type:Organization
Organization Name:MARYLAND VISION CENTER, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:THADANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-575-9580
Mailing Address - Street 1:5205 CHAIRMANS CT STE 202
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2918
Mailing Address - Country:US
Mailing Address - Phone:240-575-9580
Mailing Address - Fax:240-457-4939
Practice Address - Street 1:5205 CHAIRMANS CT STE 202
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-2918
Practice Address - Country:US
Practice Address - Phone:240-575-9580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070611207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty