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General NPI Number Information
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NPI Number | 1629331525
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Entity Type | Organization
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Legal Business Name | THURMONT EYE CARE, LLC
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Dates
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Enumeration Date | 06/17/2012
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Last Update Date | 06/17/2012
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Provider Practice Location Address
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Address Line | 2 E MAIN ST
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City | THURMONT
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State | MD
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Zip | 21788-2006
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Country | US
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Telephone | 301-271-0554
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 187
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City | THURMONT
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State | MD
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Zip | 21788-0187
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Country | US
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Telephone | 301-271-0554
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Fax |
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Authorized Official
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Title or Position | MEMBER LLC
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Name | DR. MOLLY DARA CARREN
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Credential | OD
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Telephone | 240-997-1181
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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 | TA1578
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License Number State | MD
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