Healthcare Provider Details

I. General information

NPI: 1205768876
Provider Name (Legal Business Name): WELL EYECARE PHYSICIAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 BENFIELD RD
SEVERNA PARK MD
21146-2210
US

IV. Provider business mailing address

6000 SAME VOYAGE WAY UNIT 407
CLARKSVILLE MD
21029-1375
US

V. Phone/Fax

Practice location:
  • Phone: 630-303-6301
  • Fax:
Mailing address:
  • Phone: 630-303-6301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ADEL EBRAHEEM
Title or Position: FOUNDER/MEDICAL DIRECTOR
Credential: OD, MS, FAAO
Phone: 630-303-6301