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General NPI Number Information
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NPI Number | 1104030444
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Entity Type | Organization
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Legal Business Name | TLC WHITTEN LASER EYE ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 70 THOMAS JOHNSON DR SUITE 120
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City | FREDERICK
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State | MD
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Zip | 21702-4361
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Country | US
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Telephone | 301-662-5190
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Fax |
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Provider Business Mailing Address
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Address Line | 16305 SWINGLEY RIDGE RD STE. 300
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City | CHESTERFIELD
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State | MO
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Zip | 63017-1777
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Country | US
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Telephone | 636-534-2360
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | BRIAN L ANDREW
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Credential |
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Telephone | 636-534-2360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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