1205704012 NPI number — MONTGOMERY EYE PHYSICIANS & SURGEONS, P.A.

Table of content: MRS. TANYA MARIE BRADLEY WATSON MS (NPI 1922393677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205704012 NPI number — MONTGOMERY EYE PHYSICIANS & SURGEONS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY EYE PHYSICIANS & SURGEONS, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205704012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11140 ROCKVILLE PIKE STE 450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-3138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-881-5888
Provider Business Mailing Address Fax Number:
301-881-2945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BANK ST STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20878-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-881-5888
Provider Business Practice Location Address Fax Number:
301-881-2945
Provider Enumeration Date:
10/24/2025

Additional Information

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
YUN
Authorized Official Middle Name:
JA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-881-5888

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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