Healthcare Provider Details

I. General information

NPI: 1003875238
Provider Name (Legal Business Name): EYE TEL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9130 GUILFORD ROAD
COLUMBIA MD
21046-2581
US

IV. Provider business mailing address

9130 GUILFORD ROAD
COLUMBIA MD
21046-2581
US

V. Phone/Fax

Practice location:
  • Phone: 301-483-6167
  • Fax: 301-483-6168
Mailing address:
  • Phone: 301-483-6167
  • Fax: 301-483-6168

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. GARY L GREGORY
Title or Position: PRESIDENT & CEO
Credential:
Phone: 301-483-6167