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General NPI Number Information
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NPI Number | 1164582441
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Entity Type | Organization
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Legal Business Name | KOMM MEDICAL EYE & VISION GROUP, LTD.
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Dates
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Enumeration Date | 12/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 111 N BROOK LN
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City | BETHESDA
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State | MD
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Zip | 20814-2610
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Country | US
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Telephone | 301-654-7180
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Fax |
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Provider Business Mailing Address
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Address Line | 111 N BROOK LN
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City | BETHESDA
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State | MD
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Zip | 20814-2610
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Country | US
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Telephone | 301-654-7180
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY THEODORE KOMM
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Credential | O.D.
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Telephone | 301-654-7180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA1193
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License Number State | MD
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