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General NPI Number Information
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NPI Number | 1083883789
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Entity Type | Organization
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Legal Business Name | GLAUCOMA CONSULTANTS OF WASHINGTON
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 8420 OCEAN GTWY
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City | EASTON
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State | MD
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Zip | 21601-7169
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Country | US
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Telephone | 240-804-1234
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 651091
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City | STERLING
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State | VA
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Zip | 20165-1091
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Country | US
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Telephone | 240-804-1234
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SAMEER IMTIAZ AHMAD
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Credential | M.D.
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Telephone | 240-804-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | D53502
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License Number State | MD
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