Healthcare Provider Details

I. General information

NPI: 1194914333
Provider Name (Legal Business Name): POTOMAC EYE SURGEONS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 LAKE POTOMAC DR
POTOMAC MD
20854-1223
US

IV. Provider business mailing address

11500 LAKE POTOMAC DR
POTOMAC MD
20854-1223
US

V. Phone/Fax

Practice location:
  • Phone: 301-299-5666
  • Fax: 301-299-6021
Mailing address:
  • Phone: 301-299-5666
  • Fax: 301-299-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name: DR. LAURIE JOYCE WENGER
Title or Position: PRESIDENT
Credential: MD
Phone: 301-299-5666