Provider Demographics
NPI:1366081135
Name:MARYLAND VISION INSTITUTE
Entity type:Organization
Organization Name:MARYLAND VISION INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTUS
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-791-0888
Mailing Address - Street 1:2002 MEDICAL PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7901
Mailing Address - Country:US
Mailing Address - Phone:410-571-8733
Mailing Address - Fax:
Practice Address - Street 1:470 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4858
Practice Address - Country:US
Practice Address - Phone:301-668-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty