Provider Demographics
NPI:1548253040
Name:MD EYECARE LLC
Entity type:Organization
Organization Name:MD EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-828-5558
Mailing Address - Street 1:8625 PLEASANT PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2352
Mailing Address - Country:US
Mailing Address - Phone:410-828-5558
Mailing Address - Fax:410-823-6315
Practice Address - Street 1:8625 PLEASANT PLAINS RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2352
Practice Address - Country:US
Practice Address - Phone:410-828-5558
Practice Address - Fax:410-823-6315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1154152W00000X
MDTA1021152W00000X
MDTA1147152W00000X
MDD0022348207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD018802600Medicaid
MD407116600Medicaid
MD942LMedicare PIN
MD4028300001Medicare NSC