Healthcare Provider Details

I. General information

NPI: 1033237144
Provider Name (Legal Business Name): APPLE BLOSSOM OPTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 WEST PATRICK ST
FREDERICK MD
21702
US

IV. Provider business mailing address

1311 WEST PATRICK ST
FREDERICK MD
21702
US

V. Phone/Fax

Practice location:
  • Phone: 301-695-3206
  • Fax: 301-695-9872
Mailing address:
  • Phone: 301-695-3206
  • Fax: 301-695-9872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. THOMAS W FARRELL
Title or Position: PRESIDENT
Credential: CEO
Phone: 301-695-3206