Provider Demographics
NPI:1023872330
Name:NEUROVISION BETHESDA LLC
Entity type:Organization
Organization Name:NEUROVISION BETHESDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELLER MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-288-3975
Mailing Address - Street 1:4608 S CHELSEA LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3718
Mailing Address - Country:US
Mailing Address - Phone:301-288-3975
Mailing Address - Fax:
Practice Address - Street 1:4608 S CHELSEA LN
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3718
Practice Address - Country:US
Practice Address - Phone:301-288-3975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty