Provider Demographics
NPI:1336288224
Name:EYE SURGERY CENTER OF WHITE MARSH, LLC
Entity type:Organization
Organization Name:EYE SURGERY CENTER OF WHITE MARSH, LLC
Other - Org Name:
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:KASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-663-4466
Mailing Address - Street 1:9512 HARFORD RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3120
Mailing Address - Country:US
Mailing Address - Phone:410-663-4466
Mailing Address - Fax:410-663-4556
Practice Address - Street 1:9512 HARFORD RD
Practice Address - Street 2:SUITE 5
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-3120
Practice Address - Country:US
Practice Address - Phone:410-663-4466
Practice Address - Fax:410-663-4556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1374261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD155ZMedicare ID - Type Unspecified