Basic Information
| Provider Information | |||||||||
| NPI: | 1790999266 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BETHESDA VISION CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 E WEST HWY | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208144433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016560775 | ||||||||
| FaxNumber: | 3016565164 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 E WEST HWY | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208144433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016560775 | ||||||||
| FaxNumber: | 3016565164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | BERENHAUS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | ALAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3016560775 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TA0907 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.