Healthcare Provider Details

I. General information

NPI: 1437333853
Provider Name (Legal Business Name): BARRY M. LEBOWITZ, O.D. , M.P.H. , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12129 DARNESTOWN RD
GAITHERSBURG MD
20878-2205
US

IV. Provider business mailing address

12129 DARNESTOWN RD
GAITHERSBURG MD
20878-2205
US

V. Phone/Fax

Practice location:
  • Phone: 240-683-6222
  • Fax: 240-683-6223
Mailing address:
  • Phone: 240-683-6222
  • Fax: 240-683-6223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1358
License Number StateMD

VIII. Authorized Official

Name: DR. BARRY LEBOWITZ
Title or Position: OWNER
Credential: O.D.
Phone: 240-683-6222