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General NPI Number Information
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NPI Number | 1407106669
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Entity Type | Organization
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Legal Business Name | EYEDROP
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 2220 MARTIN LUTHER KING JR AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20020-5734
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Country | US
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Telephone | 202-678-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 MARTIN LUTHER KING JR AVE WASHINGTON
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City | WASHINGTON
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State | DC
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Zip | 20020
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Country | US
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Telephone | 202-678-2020
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Fax |
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Authorized Official
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Title or Position | GM
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Name | MR. TRACY AARONS
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Credential | L.O
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Telephone | 202-678-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 400312001219
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License Number State | DC
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