Provider Demographics
NPI:1336255827
Name:ROCKVILLE EYE SURGERY CENTER, LLC
Entity type:Organization
Organization Name:ROCKVILLE EYE SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-657-8200
Mailing Address - Street 1:4818 DEL RAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-657-8200
Mailing Address - Fax:301-657-4121
Practice Address - Street 1:4818 DEL RAY AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3014
Practice Address - Country:US
Practice Address - Phone:301-657-8200
Practice Address - Fax:301-657-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1406261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139740OtherUNITED HEALTHCARE(ALL PRO
AETNAOtherHMO 3765143
MDU7OtherBLUE CROSS BLUE SHIELD MD
605580900OtherUS DEPT OF LABOR
7637708OtherAETNA PPO
MD407253700Medicaid
3690103OtherCIGNA (ALL PRODUCTS)
DCRU3OtherBLUE CROSS BLUE SHIELD
=========OtherTRICARE/CHAMPUS
MDU7OtherBLUE CROSS BLUE SHIELD MD