MEDICARE: VISIONARY EYECARE PROFESSIONALS

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	152W00000X	Optometrist	TA1970	MD

General Provider Information

NPI Number	:	1609188341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONARY EYECARE PROFESSIONALS

Provider Business Mailing Address
First Line	:	3540 SUGARLOAF PKWY
Second Line	:	UNIT D-04
City	:	FREDERICK
State	:	MD
Zip	:	21704-7912
Country	:	US
Telephone Number	:	301-874-5777
Fax Number	:	301-874-0497

Provider Business Practice Location Address
First Line	:	3540 SUGARLOAF PKWY
Second Line	:	UNIT D-04
City	:	FREDERICK
State	:	MD
Zip	:	21704-7912
Country	:	US
Telephone Number	:	301-874-5777
Fax Number	:	301-874-0497

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT L. GERTZ
Credential	:	OD
Telephone Number	:	301-874-5777

Provider Enumeration Date	:	07/10/2010
Last Update Date	:	07/10/2010

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Directions to “VISIONARY EYECARE PROFESSIONALS ” Practice Location

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