Healthcare Provider Details

I. General information

NPI: 1346939394
Provider Name (Legal Business Name): MARYLAND PHYSICIANS EYECARE GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 S CONGRESS AVE STE 105
DELRAY BEACH FL
33445-6326
US

IV. Provider business mailing address

1615 S CONGRESS AVE STE 105
DELRAY BEACH FL
33445-6326
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-6009
  • Fax:
Mailing address:
  • Phone: 561-433-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KIRSTEN CANTRELL
Title or Position: MANAGER OF HEALTH SERVICES
Credential:
Phone: 561-208-8464