MEDICARE: OLNEY OPTICAL MED, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1780812255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLNEY OPTICAL MED, LLC

Provider Business Mailing Address
First Line	:	1950 OLD GALLOWS RD
Second Line	:	SUITE 520
City	:	VIENNA
State	:	VA
Zip	:	22182-3990
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	703-991-0514

Provider Business Practice Location Address
First Line	:	18045 GEORGIA AVE
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-2237
Country	:	US
Telephone Number	:	301-774-8100
Fax Number	:	703-991-0514

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. SUE HEALEY
Credential	:
Telephone Number	:	703-847-8899

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	06/23/2009

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Directions to “OLNEY OPTICAL MED, LLC ” Practice Location

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