NPIMap

Organization Active NPI

Shady Grove Eye & Vision Care, LLC

Doing business as Shady Grove Eye & Vision Care

  • Optometrist
  • Rockville, MD
National Provider Identifier
1023103801
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA1210 Issued in MD
Legal business name
SHADY GROVE EYE & VISION CARE, LLC
Doing business as
Shady Grove Eye & Vision Care
Practice address
15200 Shady Grove Rd
Suite 100
Rockville, MD 20850-3218
Phone
(301) 670-1212
Fax
(301) 216-9692
NPI assigned
Oct 4, 2006
Last updated
Jul 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alan N Glazier, ODNPI 1093993420
Title
President
Phone
(301) 670-1212

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TA1210 MD Primary

Addresses

Primary practice location

15200 Shady Grove Rd
Suite 100
Rockville, MD 20850-3218

Mailing address

15200 Shady Grove Rd
Suite 100
Rockville, MD 20850-3218
Phone (301) 670-1212

Other names 2

  • Shady Grove Eye & Vision Care Doing business as
  • Dr Alan N. Glazier Optometrist P.A. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040519000438 DC Part B Supplier - Clinic/Group Practice 0042209231 Receives reassigned benefits from 7 practitioners
Practice locations: Rockville, MD

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2098623Shady Grove Eye & Vision Care15200 Shady Grove Rd, Rockville, MD 20850Certificate of waiverJul 9, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1023103801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15200 SHADY GROVE RD",
            "address_2": "SUITE 100",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503218",
            "telephone_number": "301-670-1212",
            "fax_number": "301-216-9692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15200 SHADY GROVE RD",
            "address_2": "SUITE 100",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503218",
            "telephone_number": "301-670-1212",
            "fax_number": "301-216-9692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY GROVE EYE & VISION CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "GLAZIER",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-670-1212",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA1210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shady Grove Eye & Vision Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dr Alan N. Glazier Optometrist P.A.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.