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General NPI Number Information
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NPI Number | 1114206943
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Entity Type | Organization
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Legal Business Name | POOLESVILLE VISION AND CONTACT LENS SERVICE
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 20005 B FISHER AVE
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City | POOLESVILLE
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State | MD
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Zip | 20837-2408
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Country | US
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Telephone | 301-916-3214
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Fax | 301-916-3101
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Provider Business Mailing Address
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Address Line | 20005 B FISHER AVE
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City | POOLESVILLE
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State | MD
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Zip | 20837-2408
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Country | US
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Telephone | 301-916-3214
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Fax | 301-916-3101
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ROBIN MEVISSEN
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Credential | O.D.
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Telephone | 310-916-3214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | TA1222
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | TA1222
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | TA1222
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | TA1222
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License Number State | MD
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Taxonomy #5
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | TA1222
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License Number State | MD
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Taxonomy #6
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | TA1222
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License Number State | MD
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Taxonomy #7
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA1222
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License Number State | MD
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