Healthcare Provider Details

I. General information

NPI: 1245247840
Provider Name (Legal Business Name): CAPITAL EYE PHYSICIANS & SURGEONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MITCHELLVILLE RD B128
BOWIE MD
20716-3104
US

IV. Provider business mailing address

PO BOX 41534
BALTIMORE MD
21203-6534
US

V. Phone/Fax

Practice location:
  • Phone: 202-529-5200
  • Fax: 202-269-3462
Mailing address:
  • Phone: 202-529-5200
  • Fax: 202-269-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHAEL EDWARD HUSTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 202-529-5200