Healthcare Provider Details

I. General information

NPI: 1508701582
Provider Name (Legal Business Name): MARYLAND VISION SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 W 7TH ST STE 400B
FREDERICK MD
21701-8532
US

IV. Provider business mailing address

1003 W 7TH ST STE 400B
FREDERICK MD
21701-8532
US

V. Phone/Fax

Practice location:
  • Phone: 240-575-9580
  • Fax: 240-457-4939
Mailing address:
  • Phone: 240-575-9580
  • Fax: 240-457-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SUNIL THADANI
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 240-575-9580