1548773278 NPI number — MOBILE EYE CARE OF MARYLAND

Table of content: (NPI 1548773278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548773278 NPI number — MOBILE EYE CARE OF MARYLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE EYE CARE OF MARYLAND
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:
1548773278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16701 MELFORD BLVD
Provider Second Line Business Mailing Address:
SUITE 400-#3487
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20715-4411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-204-3939
Provider Business Mailing Address Fax Number:
888-609-9664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16701 MELFORD BLVD
Provider Second Line Business Practice Location Address:
SUITE 400-#3487
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20715-4411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-204-3939
Provider Business Practice Location Address Fax Number:
888-609-9664
Provider Enumeration Date:
11/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
GRILLO
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
PRESIDENT / DIRECTOR
Authorized Official Telephone Number:
443-204-3939

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA1396 , 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: 357039800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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