Healthcare Provider Details

I. General information

NPI: 1003671413
Provider Name (Legal Business Name): WEPS OBS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 WISCONSIN AVE STE 850
CHEVY CHASE MD
20815-6940
US

IV. Provider business mailing address

5454 WISCONSIN AVE STE 850
CHEVY CHASE MD
20815-6940
US

V. Phone/Fax

Practice location:
  • Phone: 301-654-5700
  • Fax:
Mailing address:
  • Phone: 301-654-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENNETH SCHWARTZ
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 301-654-5700