Provider Demographics
NPI:1700069713
Name:JAMES A. BUSACK, EYEMD, LLC
Entity type:Organization
Organization Name:JAMES A. BUSACK, EYEMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BUSACK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-668-2020
Mailing Address - Street 1:470 W PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4858
Mailing Address - Country:US
Mailing Address - Phone:301-668-2020
Mailing Address - Fax:301-620-8729
Practice Address - Street 1:470 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4858
Practice Address - Country:US
Practice Address - Phone:301-668-2020
Practice Address - Fax:301-620-8729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH31629207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty