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General NPI Number Information
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NPI Number | 1669912788
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Entity Type | Organization
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Legal Business Name | EAGLE EYE SURGERY CENTER LLC
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 15001 DUFIEF MILL RD
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City | NORTH POTOMAC
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State | MD
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Zip | 20878-2599
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Country | US
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Telephone | 301-279-9123
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Fax | 301-279-6828
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Provider Business Mailing Address
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Address Line | 15020 SHADY GROVE RD SUITE 302
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City | ROCKVILLE
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State | MD
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Zip | 20850-3364
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Country | US
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Telephone | 301-279-9123
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Fax | 301-279-6828
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Authorized Official
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Title or Position | OWNER
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Name | TOUFIC S MELKI
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Credential | M.D.
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Telephone | 301-279-9123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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