Provider Demographics
NPI:1104975150
Name:EYE TECH LLC
Entity type:Organization
Organization Name:EYE TECH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MITTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-722-6480
Mailing Address - Street 1:506 N CENTRE STREET
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:301-722-6480
Mailing Address - Fax:301-722-6294
Practice Address - Street 1:506 N CENTRE STREET
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-722-6480
Practice Address - Fax:301-722-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD763448000Medicaid
MD763448000Medicaid
T59954Medicare UPIN