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General NPI Number Information
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NPI Number | 1154451219
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Entity Type | Organization
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Legal Business Name | CAPITAL EYE PHYSICIANS & SURGEONS, LLC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 4000 MITCHELLVILLE RD SUITE B-128
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City | BOWIE
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State | MD
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Zip | 20716-3104
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Country | US
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Telephone | 301-809-6305
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Fax | 301-809-6306
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Provider Business Mailing Address
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Address Line | 4000 MITCHELLVILLE RD SUITE B-128
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City | BOWIE
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State | MD
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Zip | 20716-3104
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Country | US
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Telephone | 301-809-6305
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Fax | 301-809-6306
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. WENDY D KAUTZ
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Credential | CSA
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Telephone | 301-809-6305
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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 |
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License Number State |
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