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General NPI Number Information
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NPI Number | 1689096497
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Entity Type | Organization
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Legal Business Name | DAVID Z. EPHRAIM, O.D., LLC
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 10518 CONNECTICUT AVE LOWR LEVEL
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City | KENSINGTON
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State | MD
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Zip | 20895-2469
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Country | US
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Telephone | 301-942-2221
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Fax | 301-942-6338
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Provider Business Mailing Address
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Address Line | 10518 CONNECTICUT AVE LOWR LEVEL
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City | KENSINGTON
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State | MD
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Zip | 20895-2469
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Country | US
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Telephone | 301-942-2221
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Fax | 301-942-6338
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Authorized Official
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Title or Position | SOLE MEMBER LLC
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Name | DAVID ZACHARY EPHRAIM
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Credential | O.D.
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Telephone | 301-942-2221
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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 | TA2283
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License Number State | MD
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