Organization
EYE RESTORATION CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS MEAKEM OCULARIST (OWNER)
(301) 599-6300
Entity
Organization
Contact information
Practice address
9450 PENNSYLVANIA AVE, SUITE #15, UPPER MARLBORO, MD 20772-3665
(301) 599-6300
(301) 599-0578
Mailing address
9450 PENNSYLVANIA AVE, SUITE #15, UPPER MARLBORO, MD 20772-3665
(301) 599-6300
(301) 599-0578
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
3853
MD
332BC3200X
Customized Equipment (DME)
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023053600
—
DC
01
—
30877
KAISER PERMANANTE
MD
01
—
406540466
MEDICARE RR
DC
05
—
468228900
—
MD
Enumeration date
02/21/2007
Last updated
03/21/2012
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