NPIMap

Organization Active NPI

Advanced Eye Care Medical Center

  • Ophthalmology Physician
  • Glenn Dale, MD
National Provider Identifier
1124460621
Registry record updated Mar 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
ADVANCED EYE CARE MEDICAL CENTER
Practice address
12200 Annapolis Rd
Suite 116
Glenn Dale, MD 20769-9182
Phone
(301) 805-4664
NPI assigned
Jul 24, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2016

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

Authorized official

Name
Renee C Bovelle, MD
Title
Owner
Phone
(301) 805-4664

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

12200 Annapolis Rd
Suite 116
Glenn Dale, MD 20769-9182

Mailing address

12200 Annapolis Rd
Suite 116
Glenn Dale, MD 20769-9182
Phone (301) 805-4664

Other names 1

  • Envision Eye & Laser Center Former legal business name

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
21D2074338Envision Eye & Laser Center12200 Annapolis Road Suite 116, Glenn Dale, MD 20769Certificate of waiverJul 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
Advanced Eye Care Medical Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12200 Annapolis Rd
Ste 116
Glenn Dale, MD 20769
Phone (301) 571-0000

NPI Registry JSON

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

{
    "created_epoch": "1374624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1124460621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12200 ANNAPOLIS RD",
            "address_2": "SUITE 116",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699182",
            "telephone_number": "301-805-4664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 ANNAPOLIS RD",
            "address_2": "SUITE 116",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699182",
            "telephone_number": "301-805-4664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED EYE CARE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-24",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "BOVELLE",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-805-4664",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Envision Eye & Laser Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Glenn Dale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.