Organization
EYEROSIE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIDDIQUI HERNANDEZ (OWNER)
(443) 741-8920
Entity
Organization
Contact information
Practice address
4500 FORBES BLVD STE 200, LANHAM, MD 20706-6316
(443) 741-8920
(443) 203-2617
Mailing address
4500 FORBES BLVD STE 200, LANHAM, MD 20706-6316
(443) 741-8920
(443) 203-2617
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
R205786
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R205786
STATE LICENSE
MD
Enumeration date
06/11/2017
Last updated
07/21/2022
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