NPIMap

Organization Active NPI

Medical Eye Center PA

  • Ophthalmology Physician
  • Olney, MD
National Provider Identifier
1417080854
Registry record updated May 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MEDICAL EYE CENTER PA
Practice address
3402 Olandwood CT
Olney, MD 20832-1384
Phone
(301) 774-2750
Fax
(301) 774-2756
NPI assigned
Mar 14, 2007
Reactivated
Mar 5, 2008
Last updated
May 16, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2011

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

Authorized official

Name
Mrs. Deborah Ann Phelps
Title
Office Manager
Phone
(301) 774-2750

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X DC Primary

Addresses

Primary practice location

3402 Olandwood CT
Olney, MD 20832-1384

Mailing address

3402 Olandwood CT
Olney, MD 20832-1384
Phone (301) 774-2750

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040225001104 DC Part B Supplier - Clinic/Group Practice 4789570722 Receives reassigned benefits from 8 practitioners
Practice locations: Olney, MD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
21D2093576Medical Eye Center, PA3402 Olandwood Court, Olney, MD 20832Certificate of waiverMar 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Medical Eye 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

6435 Dobbin Rd
Columbia, MD 21045
Phone (410) 465-2727

Practitioners & affiliated clinicians

Practitioners 8

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": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305504000000",
    "number": "1417080854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3402 OLANDWOOD CT",
            "city": "OLNEY",
            "state": "MD",
            "postal_code": "208321384",
            "telephone_number": "301-774-2750",
            "fax_number": "301-774-2756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3402 OLANDWOOD CT",
            "city": "OLNEY",
            "state": "MD",
            "postal_code": "208321384",
            "telephone_number": "301-774-2750",
            "fax_number": "301-774-2756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL EYE CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2011-05-16",
        "deactivation_date": "2007-11-09",
        "reactivation_date": "2008-03-05",
        "status": "A",
        "authorized_official_last_name": "PHELPS",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "301-774-2750",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "DC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olney, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; 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.