Provider Demographics
NPI:1881710507
Name:WASHINGTON CENTER FOR COSMETIC EYELID SURGERY, LLC
Entity type:Organization
Organization Name:WASHINGTON CENTER FOR COSMETIC EYELID SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-256-3646
Mailing Address - Street 1:373 ARBOR CIR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4534
Mailing Address - Country:US
Mailing Address - Phone:610-564-2774
Mailing Address - Fax:610-566-6107
Practice Address - Street 1:8180 GREENSBORO DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3888
Practice Address - Country:US
Practice Address - Phone:610-564-2774
Practice Address - Fax:610-566-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239631207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty