{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "MOBILE EYE CARE OF MARYLAND",
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"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "16701 MELFORD BLVD",
"SecondLineMailingAddress": "SUITE 400-#3487",
"MailingAddressCityName": "BOWIE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20715-4411",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "443-204-3939",
"MailingAddressFaxNumber": "888-609-9664",
"FirstLinePracticeLocationAddress": "16701 MELFORD BLVD",
"SecondLinePracticeLocationAddress": "SUITE 400-#3487",
"PracticeLocationAddressCityName": "BOWIE",
"PracticeLocationAddressStateName": "MD",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "443-204-3939",
"PracticeLocationAddressFaxNumber": "888-609-9664",
"EnumerationDate": "11/16/2017",
"LastUpdateDate": "10/13/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRILLO",
"AuthorizedOfficialFirstName": "TERESA",
"AuthorizedOfficialMiddleName": "MARIA",
"AuthorizedOfficialTitle": "PRESIDENT / DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "443-204-3939",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "TA1396",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}