Provider Demographics
NPI:1750720991
Name:DRS ELY AND COHEN OPTOMETRY OF MAPLE LAWN LLC
Entity type:Organization
Organization Name:DRS ELY AND COHEN OPTOMETRY OF MAPLE LAWN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:REID
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-946-2550
Mailing Address - Street 1:7625 MAPLE LAWN BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2565
Mailing Address - Country:US
Mailing Address - Phone:301-490-2020
Mailing Address - Fax:301-490-2224
Practice Address - Street 1:7625 MAPLE LAWN BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2565
Practice Address - Country:US
Practice Address - Phone:301-490-2020
Practice Address - Fax:301-490-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0775152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
143679Medicare PIN
127343Medicare PIN
127336Medicare PIN