Basic Information
| Provider Information | |||||||||
| NPI: | 1942962444 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHESAPEAKE EYE CARE & LASER CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8138 WATSON ST | ||||||||
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| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221024416 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 8138 WATSON ST | ||||||||
| Address2: | |||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221024416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038275454 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2021 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | SCOTT | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4105717998 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.