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General NPI Number Information
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NPI Number | 1235489030
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Entity Type | Organization
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Legal Business Name | FIRST SIGHT VISION CARE LLC
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 11/02/2012
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Provider Practice Location Address
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Address Line | 8160 MAPLE LAWN BLVD SUITE 140
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City | FULTON
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State | MD
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Zip | 20759
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Country | US
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Telephone | 443-804-1173
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Fax |
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Provider Business Mailing Address
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Address Line | 8315 ACADEMY RD
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-6687
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Country | US
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Telephone | 443-804-1173
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Fax |
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Authorized Official
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Title or Position | OWNER/PRINCIPAL
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Name | DR. NUTAPORN SUKONTASUP
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Credential | O.D.
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Telephone | 443-804-1173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | MD
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