MEDICARE: THE OCULOFACIAL CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1194688606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE OCULOFACIAL CENTER, LLC

Provider Business Mailing Address
First Line	:	6420 ROCKLEDGE DR STE 4300
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-7850
Country	:	US
Telephone Number	:	301-900-5379
Fax Number	:

Provider Business Practice Location Address
First Line	:	6420 ROCKLEDGE DR STE 4300
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-7850
Country	:	US
Telephone Number	:	301-900-5379
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VIRAJ MEHTA
Credential	:	MD
Telephone Number	:	513-518-7019

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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