Healthcare Provider Details

I. General information

NPI: 1245193838
Provider Name (Legal Business Name): MARYLAND VISION SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 THOMAS JOHNSON DR STE 150
FREDERICK MD
21702-4973
US

IV. Provider business mailing address

112 THOMAS JOHNSON DR STE 150
FREDERICK MD
21702-4973
US

V. Phone/Fax

Practice location:
  • Phone: 443-433-0029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY RIOS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 443-433-0029