Provider Demographics
NPI:1013721562
Name:SHORE REGIONAL EYE CARE, LLC
Entity type:Organization
Organization Name:SHORE REGIONAL EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, DPT
Authorized Official - Phone:609-828-2651
Mailing Address - Street 1:11810 MAN O WAR LN
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3362
Mailing Address - Country:US
Mailing Address - Phone:609-828-2651
Mailing Address - Fax:443-228-6040
Practice Address - Street 1:9956 N MAIN ST UNIT 4
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1077
Practice Address - Country:US
Practice Address - Phone:609-828-2651
Practice Address - Fax:443-228-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty