Provider Demographics
NPI:1184953788
Name:URBANA EYE CARE LLC
Entity type:Organization
Organization Name:URBANA EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:
Authorized Official - Last Name:GAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-810-5104
Mailing Address - Street 1:8925 FINGERBOARD RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8163
Mailing Address - Country:US
Mailing Address - Phone:301-810-5104
Mailing Address - Fax:301-810-5105
Practice Address - Street 1:8925 FINGERBOARD RD
Practice Address - Street 2:SUITE E
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8163
Practice Address - Country:US
Practice Address - Phone:301-810-5104
Practice Address - Fax:301-810-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty