Healthcare Provider Details

I. General information

NPI: 1992121669
Provider Name (Legal Business Name): AMLAMI 2, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 COLESVILLE RD
SILVER SPRING MD
20901-2426
US

IV. Provider business mailing address

10101 COLESVILLE RD
SILVER SPRING MD
20901-2426
US

V. Phone/Fax

Practice location:
  • Phone: 301-754-0101
  • Fax: 301-754-0103
Mailing address:
  • Phone: 301-754-0101
  • Fax: 301-754-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberDA0637
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUDITH POLLAK
Title or Position: OWNER
Credential:
Phone: 301-754-0101