Provider Demographics
NPI:1245247840
Name:CAPITAL EYE PHYSICIANS & SURGEONS LLC
Entity type:Organization
Organization Name:CAPITAL EYE PHYSICIANS & SURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-529-5200
Mailing Address - Street 1:PO BOX 41534
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21203-6534
Mailing Address - Country:US
Mailing Address - Phone:202-529-5200
Mailing Address - Fax:202-269-3462
Practice Address - Street 1:4000 MITCHELLVILLE RD
Practice Address - Street 2:B128
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3104
Practice Address - Country:US
Practice Address - Phone:202-529-5200
Practice Address - Fax:202-269-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6897011Medicaid
DC408680Medicare PIN