NPIMap

Organization Active NPI

Eye Restoration Clinic Inc.

  • Customized Equipment (DME)
  • Upper Marlboro, MD
National Provider Identifier
1174668693
Registry record updated Mar 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
Legal business name
EYE RESTORATION CLINIC INC.
Practice address
9450 Pennsylvania Ave
Suite #15
Upper Marlboro, MD 20772-3665
Phone
(301) 599-6300
Fax
(301) 599-0578
NPI assigned
Feb 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2012

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

Authorized official

Name
Mr. Thomas Meakem, OCULARISTNPI 1013174549
Title
Owner
Phone
(301) 599-6300

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
OcularistGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1700X 3853 MD
Customized Equipment (DME) 332BC3200X MD Primary

Addresses

Primary practice location

9450 Pennsylvania Ave
Suite #15
Upper Marlboro, MD 20772-3665

Mailing address

9450 Pennsylvania Ave
Suite #15
Upper Marlboro, MD 20772-3665
Phone (301) 599-6300

Other identifiers 4

IdentifierTypeStateIssuer
30877OtherMDKAISER PERMANANTE
406540466OtherDCMEDICARE RR
023053600MedicaidDC
468228900MedicaidMD

National Provider Directory

National Provider Directory

Locations

9450 Pennsylvania Ave
Ste 15
Uppr Marlboro, MD 20772
Phone (301) 599-6300

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332288000000",
    "number": "1174668693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9450 PENNSYLVANIA AVE",
            "address_2": "SUITE #15",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207723665",
            "telephone_number": "301-599-6300",
            "fax_number": "301-599-0578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9450 PENNSYLVANIA AVE",
            "address_2": "SUITE #15",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207723665",
            "telephone_number": "301-599-6300",
            "fax_number": "301-599-0578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE RESTORATION CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2012-03-21",
        "status": "A",
        "authorized_official_last_name": "MEAKEM",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-599-6300",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OCULARIST"
    },
    "taxonomies": [
        {
            "code": "156FX1700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Ocularist",
            "state": "MD",
            "license": "3853",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER PERMANANTE",
            "identifier": "30877",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "406540466",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023053600",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "468228900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Upper Marlboro, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.