Healthcare Provider Details

I. General information

NPI: 1225428865
Provider Name (Legal Business Name): DIABETIC EYE & MACULAR DISEASE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE SUITE 208
WASHINGTON DC
20017-2107
US

IV. Provider business mailing address

1160 VARNUM ST NE SUITE 208
WASHINGTON DC
20017-2107
US

V. Phone/Fax

Practice location:
  • Phone: 202-399-1616
  • Fax: 866-265-5635
Mailing address:
  • Phone: 202-399-1616
  • Fax: 866-265-5635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEEVAN MATHURA JR.
Title or Position: SOLE OWNER
Credential: MD
Phone: 202-506-3479