1336255827 NPI number — ROCKVILLE EYE SURGERY CENTER, LLC

Table of content: (NPI 1336255827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336255827 NPI number — ROCKVILLE EYE SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKVILLE EYE SURGERY CENTER, 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:
Provider Other Organization Name Type Code:
6
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:
1336255827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4818 DEL RAY AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-657-8200
Provider Business Mailing Address Fax Number:
301-657-4121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4818 DEL RAY AVE
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20814-3014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-657-8200
Provider Business Practice Location Address Fax Number:
301-657-4121
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHU
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
301-657-8200

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1406 , 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: 2139740 . This is a "UNITED HEALTHCARE(ALL PRO" identifier . This identifiers is of the category "OTHER".
  • Identifier: AETNA . This is a "HMO 3765143" identifier . This identifiers is of the category "OTHER".
  • Identifier: U7 . This is a "BLUE CROSS BLUE SHIELD MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 605580900 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7637708 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 407253700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3690103 . This is a "CIGNA (ALL PRODUCTS)" identifier . This identifiers is of the category "OTHER".
  • Identifier: RU3 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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