Provider Demographics
NPI:1962560383
Name:OPHTHALMIC PLASTIC AND ORBITAL CONSULTANTS, P.C.
Entity type:Organization
Organization Name:OPHTHALMIC PLASTIC AND ORBITAL CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-571-0000
Mailing Address - Street 1:6420 ROCKLEDGE DRIVE
Mailing Address - Street 2:SUITE 4300
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:301-571-0000
Mailing Address - Fax:301-571-0853
Practice Address - Street 1:6420 ROCKLEDGE DRIVE
Practice Address - Street 2:SUITE 4300
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-571-0000
Practice Address - Fax:301-571-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
824039Medicare ID - Type UnspecifiedMETROPOLITAN AREA MEDICAR