Healthcare Provider Details

I. General information

NPI: 1174329502
Provider Name (Legal Business Name): ADVANCED EYE LASER AND SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 RIDGEBROOK RD STE 300
SPARKS MD
21152-9440
US

IV. Provider business mailing address

1600 6TH AVE STE 119B
YORK PA
17403-2627
US

V. Phone/Fax

Practice location:
  • Phone: 410-618-5640
  • Fax: 410-846-6905
Mailing address:
  • Phone: 717-650-6148
  • Fax: 443-927-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUDEEP PRAMANIK
Title or Position: PRESIDENT
Credential: MD
Phone: 717-599-2747