Healthcare Provider Details

I. General information

NPI: 1871613091
Provider Name (Legal Business Name): VISION CENTER OPTICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13808 GEORGIA AVE
SILVER SPRING MD
20906
US

IV. Provider business mailing address

13808 GEORGIA AVE
SILVER SPRING MD
20906
US

V. Phone/Fax

Practice location:
  • Phone: 301-871-6454
  • Fax: 301-871-6477
Mailing address:
  • Phone: 301-871-6454
  • Fax: 301-871-6477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberDA0890
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1101003357
License Number StateVA

VIII. Authorized Official

Name: MR. ROBERT BOJARSKI
Title or Position: OPTICIAN OWNER
Credential: DO
Phone: 301-770-7084