Provider Demographics
NPI:1427324870
Name:WASHINGTON EYE SPECIALISTS
Entity type:Organization
Organization Name:WASHINGTON EYE SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANCAYCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-529-5200
Mailing Address - Street 1:1160 VARNUM ST NE
Mailing Address - Street 2:STE 011
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-529-5200
Mailing Address - Fax:202-529-1476
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:STE 011
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-529-5200
Practice Address - Fax:202-529-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD2417OtherEYEMED
DC17247OtherCHARTERED HEALTH
DC27558OtherCHARTERED HEALTH
DCMD5025OtherEYEMED
DC71730002OtherBLUE CROSS BLUE SHIELD
MD388000100Medicaid
DCG02434OtherMEDICARE P-TAN