NPIMap

Organization Active NPI

Maryland Eye Physician and Surgeon, LLC

Doing business as Maryland Eye Center

  • Ophthalmology Physician
  • Rockville, MD
National Provider Identifier
1508136029
Registry record updated Dec 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
D0061666 Issued in MD
Legal business name
MARYLAND EYE PHYSICIAN AND SURGEON, LLC
Doing business as
Maryland Eye Center
Practice address
2403 Research Blvd Ste 102
Suite 102
Rockville, MD 20850-6233
Phone
(240) 671-3808
Fax
(240) 232-2016
NPI assigned
Jan 2, 2012
Last updated
Dec 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2023

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

Authorized official

Name
Dr. Alisa Kim, M.D.NPI 1114968336
Title
Medical Director
Phone
(240) 671-3808

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
Ophthalmology Physician 207W00000X D0061666 MD Primary

Addresses

Primary practice location

2403 Research Blvd Ste 102
Suite 102
Rockville, MD 20850-6233

Mailing address

11217 Korman Dr
Potomac, MD 20854-2049
Phone (240) 671-3808

Other identifiers 2

IdentifierTypeStateIssuer
331604100MedicaidMD
405809700MedicaidMD

Other names 1

  • Maryland Eye Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120301000456 DC Part B Supplier - Clinic/Group Practice 7113185604 Receives reassigned benefits from 1 practitioner
Practice locations: Chevy Chase, MD; Rockville, MD; Potomac, MD
O20120802000479 MD Part B Supplier - Clinic/Group Practice 7113185604 Receives reassigned benefits from 1 practitioner
Practice locations: Baltimore, MD; Lutherville, MD; Rockville, MD

National Provider Directory

National Provider Directory

Locations

2403 Research Blvd
Ste 102
Rockville, MD 20850
Phone (240) 232-2020

Practitioners & affiliated clinicians

Practitioners 1

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": "1325462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701388800000",
    "number": "1508136029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11217 KORMAN DR",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208542049",
            "telephone_number": "240-671-3808",
            "fax_number": "240-232-2016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 RESEARCH BLVD STE 102",
            "address_2": "SUITE 102",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208506233",
            "telephone_number": "240-671-3808",
            "fax_number": "240-232-2016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND EYE PHYSICIAN AND SURGEON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-02",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "ALISA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "240-671-3808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MD",
            "license": "D0061666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331604100",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "405809700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maryland Eye Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maryland Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.