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General NPI Number Information
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NPI Number | 1871789172
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Entity Type | Organization
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Legal Business Name | INTERGALACTIC CENTER FOR ADVANCED CATARACT AND CORNEAL SURGERY
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 10215 FERNWOOD RD SUITE 98
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City | BETHESDA
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State | MD
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Zip | 20817-1106
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Country | US
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Telephone | 301-493-6404
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Fax | 301-493-9694
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Provider Business Mailing Address
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Address Line | 10215 FERNWOOD RD SUITE 98
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City | BETHESDA
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State | MD
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Zip | 20817-1106
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Country | US
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Telephone | 301-493-6404
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Fax | 301-493-9694
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHAEL D DUPLESSIE
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Credential | M.D
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Telephone | 301-493-6404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | D00052880
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License Number State | MD
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