MEDICARE: CHESAPEAKE EYE CARE AND LASER CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1396603437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESAPEAKE EYE CARE AND LASER CENTER, LLC

Provider Business Mailing Address
First Line	:	2661 RIVA RD STE 1030
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7131
Country	:	US
Telephone Number	:	410-571-8733
Fax Number	:	410-571-6309

Provider Business Practice Location Address
First Line	:	411 N WASHINGTON ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2311
Country	:	US
Telephone Number	:	703-548-5588
Fax Number	:	703-549-1599

Authorized Official
Title or Position	:	PROVIDER CREDENTIALING SPECIALIST
Name	:	JENNIFER EMINIZER
Credential	:
Telephone Number	:	667-354-5528

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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