Healthcare Provider Details

I. General information

NPI: 1780254086
Provider Name (Legal Business Name): ENVUE SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WATERFRONT ST STE 300
OXON HILL MD
20745-1142
US

IV. Provider business mailing address

7014 OREGON AVE NW
WASHINGTON DC
20015-1422
US

V. Phone/Fax

Practice location:
  • Phone: 301-485-9533
  • Fax:
Mailing address:
  • Phone: 202-210-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BRUCE ANTHONY RIVERS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 202-210-4338