Healthcare Provider Details

I. General information

NPI: 1255390670
Provider Name (Legal Business Name): CARROLL COUNTY EYE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 MALCOLM DR SUITE B
WESTMINSTER MD
21157-6160
US

IV. Provider business mailing address

410 MALCOLM DR STE B
WESTMINSTER MD
21157-6160
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-3438
  • Fax: 410-871-3428
Mailing address:
  • Phone: 410-871-3438
  • Fax: 410-871-3429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1394
License Number StateMD

VIII. Authorized Official

Name: MR. MICHAEL PASCETTA
Title or Position: CFO
Credential:
Phone: 860-652-5002