Active NPI
Advanced Eye Care Medical Center, PA
- Ophthalmology Physician
- Glenn Dale, MD
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- D0056686
- Legal business name
- ADVANCED EYE CARE MEDICAL CENTER, PA
- Practice address
- 12200 Annapolis Rd
Suite 116
Glenn Dale, MD 20769-9182 - Phone
- (301) 805-4664
- Fax
- (301) 805-4663
- NPI assigned
- May 14, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Renee Bovelle, M.D.
- Title
- Owner
- Phone
- (301) 805-4664
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | D0056686 | MD | 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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Advanced Eye Care Medical Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Ophthalmology Physician
- Glenn Dale, MD
- NPI 1124460621
Locations
15616 Emerald Way
Bowie, MD 20716
Phone (301) 860-1802
12200 Annapolis Rd
Glenn Dale, MD 20769
Phone (301) 805-4664
5711 Sarvis Ave
Ste 508
Riverdale, MD 20737
Phone (301) 466-2197
Interoperability endpoints
- https://api.platform.athenahealth.com/2410/brand/1/csg/1/fhir/r4
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": "1179100800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1369267200000",
"number": "1790990505",
"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",
"fax_number": "301-805-4663"
},
{
"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",
"fax_number": "301-805-4663"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADVANCED EYE CARE MEDICAL CENTER, PA",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-14",
"last_updated": "2013-05-23",
"status": "A",
"authorized_official_last_name": "BOVELLE",
"authorized_official_first_name": "RENEE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "301-805-4664",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": "MD",
"license": "D0056686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 May 23, 2013; 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.