Healthcare Provider Details

I. General information

NPI: 1780812255
Provider Name (Legal Business Name): OLNEY OPTICAL MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18045 GEORGIA AVE
OLNEY MD
20832-2237
US

IV. Provider business mailing address

1950 OLD GALLOWS RD SUITE 520
VIENNA VA
22182-3990
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-8100
  • Fax: 703-991-0514
Mailing address:
  • Phone: 703-847-8899
  • Fax: 703-991-0514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. SUE HEALEY
Title or Position: PRESIDENT
Credential:
Phone: 703-847-8899