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General NPI Number Information
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NPI Number | 1194914408
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Entity Type | Organization
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Legal Business Name | EYE DESIGN, INC
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 7801 OLD BRANCH AVE SUITE 103
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City | CLINTON
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State | MD
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Zip | 20735-1608
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Country | US
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Telephone | 301-868-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 7801 OLD BRANCH AVE SUITE 103
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City | CLINTON
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State | MD
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Zip | 20735-1608
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Country | US
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Telephone | 301-868-9090
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MR. JOHN L BURNS
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Credential | OD
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Telephone | 301-868-9090
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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 | TA1051
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License Number State | MD
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