1952337107 NPI number — EASTON EYE SURGERY CENTER, LLC

Table of content: DR. JOHN PAUL GROVE DDS (NPI 1104989359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952337107 NPI number — EASTON EYE SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTON 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:
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:
1952337107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 DUTCHMANS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21601-4334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-822-7931
Provider Business Mailing Address Fax Number:
410-822-3523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 DUTCHMANS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21601-4334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-822-7931
Provider Business Practice Location Address Fax Number:
410-822-3523
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DYER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
KAVANAUGH
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
410-822-7931

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1431 , 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)





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