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General NPI Number Information
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NPI Number | 1225428865
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Entity Type | Organization
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Legal Business Name | DIABETIC EYE & MACULAR DISEASE SPECIALISTS LLC
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Dates
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Enumeration Date | 02/04/2015
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 1160 VARNUM ST NE SUITE 208
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City | WASHINGTON
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State | DC
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Zip | 20017-2107
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Country | US
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Telephone | 202-399-1616
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Fax | 866-265-5635
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Provider Business Mailing Address
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Address Line | 1160 VARNUM ST NE SUITE 208
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City | WASHINGTON
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State | DC
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Zip | 20017-2107
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Country | US
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Telephone | 202-399-1616
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Fax | 866-265-5635
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Authorized Official
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Title or Position | SOLE OWNER
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Name | JEEVAN MATHURA JR.
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Credential | MD
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Telephone | 202-506-3479
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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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