Healthcare Provider Details

I. General information

NPI: 1184953788
Provider Name (Legal Business Name): URBANA EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8925 FINGERBOARD RD SUITE E
FREDERICK MD
21704-8163
US

IV. Provider business mailing address

8925 FINGERBOARD RD SUITE E
FREDERICK MD
21704-8163
US

V. Phone/Fax

Practice location:
  • Phone: 301-810-5104
  • Fax: 301-810-5105
Mailing address:
  • Phone: 301-810-5104
  • Fax: 301-810-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1469
License Number StateMD

VIII. Authorized Official

Name: DR. IRVING GAN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 301-810-5104