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General NPI Number Information
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NPI Number | 1740856798
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Entity Type | Organization
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Legal Business Name | PEAS LLC
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 3272 BENNETT CREEK AVE UNIT B
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City | FREDERICK
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State | MD
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Zip | 21704-7653
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Country | US
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Telephone | 301-732-7988
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Fax | 301-732-7881
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Provider Business Mailing Address
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Address Line | 9308 BISHOPGATE DR
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City | FREDERICK
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State | MD
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Zip | 21704-7356
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Country | US
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Telephone | 301-385-2840
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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. ASHLEY WONG
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Credential | OD
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Telephone | 301-385-2840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number |
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License Number State |
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