Healthcare Provider Details

I. General information

NPI: 1255347050
Provider Name (Legal Business Name): MARYLAND EYE SURGERY CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRINCE FREDERICK BLVD.
PRINCE FREDERICK MD
20678
US

IV. Provider business mailing address

800 PRINCE FREDERICK BLVD.
PRINCE FREDERICK MD
20678
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-2270
  • Fax: 410-535-5749
Mailing address:
  • Phone: 410-535-2270
  • Fax: 410-535-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1333
License Number StateMD

VIII. Authorized Official

Name: MR. DONALD BARTNICK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 410-535-2270