Provider Demographics
NPI:1548152911
Name:CHESAPEAKE EYE CARE AND LASER CENTER, LLC
Entity type:Organization
Organization Name:CHESAPEAKE EYE CARE AND LASER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALISTS
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-228-6971
Mailing Address - Street 1:2661 RIVA RD STE 1030
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7131
Mailing Address - Country:US
Mailing Address - Phone:410-571-8733
Mailing Address - Fax:
Practice Address - Street 1:11637 TERRACE DR STE 103
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3707
Practice Address - Country:US
Practice Address - Phone:301-895-2020
Practice Address - Fax:301-302-0012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESAPEAKE EYE CARE & LASER CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty