NPIMap

Individual provider Active NPI

Maribel Racho Obenza, O.D.

  • Optometrist
  • Rockville, MD
National Provider Identifier
1770861775
Registry record updated Jul 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA2262 Issued in MD
Practice address
1401 Rockville Pike
Suite 100
Rockville, MD 20852-1428
Phone
(301) 468-9000
Fax
(301) 309-9355
NPI assigned
Jul 26, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TA2262 MD Primary

Addresses

Primary practice location

1401 Rockville Pike
Suite 100
Rockville, MD 20852-1428

Mailing address

5225 Pooks Hill Rd
Apt. #214-South
Bethesda, MD 20814-2052

Other identifiers 1

IdentifierTypeStateIssuer
12266068OtherMDCAQH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
National Vision, Inc. Optometrist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311638400000",
    "number": "1770861775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5225 POOKS HILL RD",
            "address_2": "APT. #214-SOUTH",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208142052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 ROCKVILLE PIKE",
            "address_2": "SUITE 100",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208521428",
            "telephone_number": "301-468-9000",
            "fax_number": "301-309-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBENZA",
        "first_name": "MARIBEL",
        "middle_name": "RACHO",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-26",
        "last_updated": "2011-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12266068",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 26, 2011; 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.