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General NPI Number Information
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NPI Number | 1417239856
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Entity Type | Organization
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Legal Business Name | MARYLAND VISION SERVICES LLC
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 1895 L ST NW
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City | WASHINGTON
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State | DC
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Zip | 20036-3801
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Country | US
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Telephone | 202-659-3646
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Fax |
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Provider Business Mailing Address
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Address Line | 5905 33RD AVE
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City | HYATTSVILLE
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State | MD
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Zip | 20782-2917
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Country | US
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Telephone | 706-761-8920
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MARIETTA DAWSON
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Credential | O.D.
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Telephone | 706-761-8920
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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 |
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License Number State |
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