Provider Demographics
NPI:1871937268
Name:MONTGOMERY VILLAGE EYE CENTER INC
Entity type:Organization
Organization Name:MONTGOMERY VILLAGE EYE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-869-4070
Mailing Address - Street 1:18310 MONTGOMERY VILLAGE AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3556
Mailing Address - Country:US
Mailing Address - Phone:301-698-4070
Mailing Address - Fax:301-869-0397
Practice Address - Street 1:18310 MONTGOMERY VILLAGE AVE STE 140
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3556
Practice Address - Country:US
Practice Address - Phone:301-698-4070
Practice Address - Fax:301-869-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0991152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD276459OtherGROUP PTAN