Provider Demographics
NPI:1750556668
Name:MOUNT AIRY MEDICAL EYE CENTER
Entity type:Organization
Organization Name:MOUNT AIRY MEDICAL EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-829-3937
Mailing Address - Street 1:1001 TWIN ARCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-4138
Mailing Address - Country:US
Mailing Address - Phone:301-829-3937
Mailing Address - Fax:301-829-3650
Practice Address - Street 1:1001 TWIN ARCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-4138
Practice Address - Country:US
Practice Address - Phone:301-829-3937
Practice Address - Fax:301-829-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD1836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU97900Medicare UPIN
MD135337ZBB3Medicare PIN