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General NPI Number Information
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NPI Number | 1174329502
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Entity Type | Organization
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Legal Business Name | ADVANCED EYE LASER AND SURGERY CENTER
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 954 RIDGEBROOK RD STE 300
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City | SPARKS
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State | MD
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Zip | 21152-9440
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Country | US
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Telephone | 509-379-3077
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 6TH AVE STE 119B
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City | YORK
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State | PA
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Zip | 17403-2627
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Country | US
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Telephone | 717-650-6148
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | STEVE BOWMAN
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Credential |
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Telephone | 509-379-3077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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