1225203987 NPI number — ROCKVILLE EYE CENTER, INC.

Table of content: CASSANDRA MARIE CRUZ LMSW (NPI 1134967540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225203987 NPI number — ROCKVILLE EYE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKVILLE EYE CENTER, INC.
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:
1225203987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11125 ROCKVILLE PIKE
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-3142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-231-5222
Provider Business Mailing Address Fax Number:
301-231-0551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11125 ROCKVILLE PIKE
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852-3142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-231-5222
Provider Business Practice Location Address Fax Number:
301-231-0551
Provider Enumeration Date:
04/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WANG
Authorized Official First Name:
PEI
Authorized Official Middle Name:
Authorized Official Title or Position:
OD
Authorized Official Telephone Number:
301-231-5222

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA1573 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 416962000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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