Healthcare Provider Details

I. General information

NPI: 1316419773
Provider Name (Legal Business Name): CENTER FOR VISION DEVELOPMENT AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 W MAIN ST STE B
NEW MARKET MD
21774-6279
US

IV. Provider business mailing address

164 W MAIN ST STE B
NEW MARKET MD
21774-6279
US

V. Phone/Fax

Practice location:
  • Phone: 301-865-1800
  • Fax: 301-865-1973
Mailing address:
  • Phone: 301-865-1800
  • Fax: 301-865-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: MARSHA DAVIS BENSHIR
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 301-865-1800