Provider Demographics
NPI:1649946278
Name:VISIONARY EYECARE PROFESSIONALS
Entity type:Organization
Organization Name:VISIONARY EYECARE PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-874-5777
Mailing Address - Street 1:22610 NEWCUT RD STE E4A
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-5332
Mailing Address - Country:US
Mailing Address - Phone:301-874-5777
Mailing Address - Fax:
Practice Address - Street 1:22610 NEWCUT RD STE E4A
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-5332
Practice Address - Country:US
Practice Address - Phone:301-874-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty