1417970609 NPI number — DRS ELY AND COHEN OPTOMETRY OF MAPLE LAWN LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417970609 NPI number — DRS ELY AND COHEN OPTOMETRY OF MAPLE LAWN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS ELY AND COHEN OPTOMETRY OF MAPLE LAWN LLC
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:
MAPLE LAWN EYE CARE CENTER
Provider Other Organization Name Type Code:
3
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:
1417970609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7625 MAPLE LAWN BLVD STE 125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20759-2622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-490-2020
Provider Business Mailing Address Fax Number:
301-490-2224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7625 MAPLE LAWN BLVD STE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20759-2622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-490-2020
Provider Business Practice Location Address Fax Number:
301-490-2224
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELY
Authorized Official First Name:
JACALYN
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-490-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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