Provider Demographics
NPI:1033117718
Name:WASHINGTON EYE PHYSICIANS & SURGEONS, P.C.
Entity type:Organization
Organization Name:WASHINGTON EYE PHYSICIANS & SURGEONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLETE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-657-5700
Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:STE 950
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6901
Mailing Address - Country:US
Mailing Address - Phone:301-654-5114
Mailing Address - Fax:301-654-9132
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:STE 950
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-657-5700
Practice Address - Fax:301-654-9132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC022589600Medicaid
MD908001500Medicaid
DC022589600Medicaid
171978W78Medicare PIN