=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780531418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELL EYECARE PHYSICIAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2026
-----------------------------------------------------
Last Update Date | 03/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8820 WALTHER BLVD
-----------------------------------------------------
City | PARKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21234-9025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-303-6301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6000 SAME VOYAGE WAY UNIT 407
-----------------------------------------------------
City | CLARKSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21029-1375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-303-6301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST/ MEDICAL DIRECTOR
-----------------------------------------------------
Name | ADEL EBRAHEEM
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 630-303-6301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------