Healthcare Provider Details

I. General information

NPI: 1295615110
Provider Name (Legal Business Name): MID ATLANTIC OPTICAL SUPPLIES AND CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 NEW YORK AVE NW
WASHINGTON DC
20005-2102
US

IV. Provider business mailing address

5001 WILSON LN FL 3
BETHESDA MD
20814-2455
US

V. Phone/Fax

Practice location:
  • Phone: 202-638-4700
  • Fax:
Mailing address:
  • Phone: 202-638-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN LOBAUGH
Title or Position: OPTOMETRIST/PARTNER
Credential: OD
Phone: 202-668-1106