# MARYLAND EYE PHYSICIAN AND SURGEON, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Maryland Eye Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508136029
- **Authorized official:** DR. ALISA KIM M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (240) 671-3808

## Contact information

- **Practice address:** 2403 RESEARCH BLVD STE 102, SUITE 102, ROCKVILLE, MD 20850-6233
- **Practice address phone:** (240) 671-3808
- **Practice address fax:** (240) 232-2016
- **Mailing address:** 11217 KORMAN DR, POTOMAC, MD 20854-2049
- **Mailing address phone:** (240) 671-3808
- **Mailing address fax:** (240) 232-2016

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | D0061666 | MD | Yes |

## Other

- **Enumeration date:** 01/02/2012
- **Last updated:** 12/01/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 331604100 | — | MD |
| 05 | — | 405809700 | — | MD |