Healthcare Provider Details

I. General information

NPI: 1205704012
Provider Name (Legal Business Name): MONTGOMERY EYE PHYSICIANS & SURGEONS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BANK ST STE 220
GAITHERSBURG MD
20878-1503
US

IV. Provider business mailing address

11140 ROCKVILLE PIKE STE 450
ROCKVILLE MD
20852-3138
US

V. Phone/Fax

Practice location:
  • Phone: 301-881-5888
  • Fax: 301-881-2945
Mailing address:
  • Phone: 301-881-5888
  • Fax: 301-881-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: YUN JA PARK
Title or Position: PRESIDENT
Credential:
Phone: 301-881-5888