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General NPI Number Information
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NPI Number | 1255390670
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Entity Type | Organization
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Legal Business Name | CARROLL COUNTY EYE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 04/20/2016
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Provider Practice Location Address
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Address Line | 410 MALCOLM DR SUITE B
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City | WESTMINSTER
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State | MD
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Zip | 21157-6160
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Country | US
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Telephone | 410-871-3438
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Fax | 410-871-3428
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Provider Business Mailing Address
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Address Line | 410 MALCOLM DR SUITE B
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City | WESTMINSTER
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State | MD
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Zip | 21157-6160
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Country | US
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Telephone | 410-871-3438
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Fax | 410-871-3428
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. ANGELA ROBINSON
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Credential |
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Telephone | 410-871-3438
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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 | A1394
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License Number State | MD
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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 | A1394
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License Number State | MD
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